Healthcare Provider Details

I. General information

NPI: 1982179990
Provider Name (Legal Business Name): NEWINGTON DENTISTRY AND BRACES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 BERLIN TPKE UNIT 7A
NEWINGTON CT
06111-4601
US

IV. Provider business mailing address

5 MOUNT ROYAL AVE STE 300
MARLBOROUGH MA
01752-1900
US

V. Phone/Fax

Practice location:
  • Phone: 860-748-4888
  • Fax: 860-748-4887
Mailing address:
  • Phone: 508-460-0632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JOANNE TAVANO
Title or Position: CFO
Credential:
Phone: 978-580-1524