Healthcare Provider Details

I. General information

NPI: 1053305201
Provider Name (Legal Business Name): PHILIP J CONFORTI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 DIXWELL AVE STE 2A
HAMDEN CT
06514-1852
US

IV. Provider business mailing address

87 STATE ST
GUILFORD CT
06437-2723
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-3737
  • Fax: 203-230-2931
Mailing address:
  • Phone: 203-453-4381
  • Fax: 203-458-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6826
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: