Healthcare Provider Details

I. General information

NPI: 1861406639
Provider Name (Legal Business Name): CAPITOL DENTAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FINANCIAL PLZ
HARTFORD CT
06103-2608
US

IV. Provider business mailing address

1 FINANCIAL PLZ
HARTFORD CT
06103-2608
US

V. Phone/Fax

Practice location:
  • Phone: 860-247-5130
  • Fax: 860-524-9000
Mailing address:
  • Phone: 860-247-5130
  • Fax: 860-524-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY BRUCE HAROIAN
Title or Position: OWNER / DENTIST
Credential: DMD
Phone: 860-247-5130