Healthcare Provider Details

I. General information

NPI: 1750299921
Provider Name (Legal Business Name): CIDER MILL DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 STAFFORD RD
MANSFIELD CENTER CT
06250-1422
US

IV. Provider business mailing address

215 STAFFORD RD
MANSFIELD CENTER CT
06250-1422
US

V. Phone/Fax

Practice location:
  • Phone: 860-477-2155
  • Fax:
Mailing address:
  • Phone: 860-477-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. YIANNIS ZANNIS GAZIS
Title or Position: OWNER
Credential: DDS
Phone: 860-477-2155