Healthcare Provider Details

I. General information

NPI: 1578551677
Provider Name (Legal Business Name): ROBERT A ERNST D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 WILLARD AVE SUITE 2H
NEWINGTON CT
06111-2373
US

IV. Provider business mailing address

217 LAMPLIGHTER LN
NEWINGTON CT
06111-5237
US

V. Phone/Fax

Practice location:
  • Phone: 860-667-8277
  • Fax: 860-667-4911
Mailing address:
  • Phone: 860-667-8223
  • Fax: 860-665-8179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number004317
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: