Healthcare Provider Details

I. General information

NPI: 1366653933
Provider Name (Legal Business Name): SALVATORE JAMES SQUATRITO JR DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 TOLLAND TURNPIKE SUITE 1-C
MANCHESTER CT
06042-1759
US

IV. Provider business mailing address

360 TOLLAND TURNPIKE SUITE 1-C
MANCHESTER CT
06042-1759
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-1429
  • Fax: 860-646-6897
Mailing address:
  • Phone: 860-646-1429
  • Fax: 860-646-6897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number003946
License Number StateCT

VIII. Authorized Official

Name: DR. SALVATORE JAMES SQUATRITO JR.
Title or Position: PRESIDENT PROFESSIONAL CORPORATION
Credential: DDS
Phone: 860-646-1429