Healthcare Provider Details

I. General information

NPI: 1942352059
Provider Name (Legal Business Name): CONNECTICUT ENDODONTIC ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 TOLLAND TPKE SUITE2A
MANCHESTER CT
06042-1771
US

IV. Provider business mailing address

360 TOLLAND TPKE SUITE2A
MANCHESTER CT
06042-1771
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-4811
  • Fax: 860-645-0882
Mailing address:
  • Phone: 860-646-4811
  • Fax: 860-645-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN RUDOLPH QUATROCELLI
Title or Position: VICE PRESIDENT
Credential: D.M.D.
Phone: 860-646-4811