Healthcare Provider Details

I. General information

NPI: 1588915821
Provider Name (Legal Business Name): CANDLEWOOD DENTAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 STATE ROUTE 39
NEW FAIRFIELD CT
06812-4120
US

IV. Provider business mailing address

87 STATE ROUTE 39
NEW FAIRFIELD CT
06812-4120
US

V. Phone/Fax

Practice location:
  • Phone: 203-746-1200
  • Fax: 203-746-2315
Mailing address:
  • Phone: 203-746-1200
  • Fax: 203-746-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7208
License Number StateCT

VIII. Authorized Official

Name: LORRAINE BURIO
Title or Position: OWNER/DENTIST
Credential: D.M.D.
Phone: 203-746-1200