Healthcare Provider Details

I. General information

NPI: 1013037308
Provider Name (Legal Business Name): NORTH BRANFORD DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 NOTCH HILL RD
NORTH BRANFORD CT
06471-1826
US

IV. Provider business mailing address

PO BOX 193
NORTH BRANFORD CT
06471-0193
US

V. Phone/Fax

Practice location:
  • Phone: 203-488-6343
  • Fax: 203-488-6185
Mailing address:
  • Phone: 203-488-6343
  • Fax: 203-488-6185

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. BARRY I STARK
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 203-488-6343