Healthcare Provider Details

I. General information

NPI: 1821267667
Provider Name (Legal Business Name): OXFORD DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OXFORD RD
OXFORD CT
06478-1943
US

IV. Provider business mailing address

100 OXFORD RD
OXFORD CT
06478-1943
US

V. Phone/Fax

Practice location:
  • Phone: 203-888-6060
  • Fax:
Mailing address:
  • Phone: 203-888-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KENNETH CAPOZZI
Title or Position: OWNER
Credential:
Phone: 203-888-6060