Healthcare Provider Details

I. General information

NPI: 1588796072
Provider Name (Legal Business Name): MARY ADAMS ROLKA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 NEW BRITAIN AVE
HARTFORD CT
06106-4039
US

IV. Provider business mailing address

6 MARY RD
BURLINGTON CT
06013-2402
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-2999
  • Fax:
Mailing address:
  • Phone: 860-675-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number003719
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: