Healthcare Provider Details

I. General information

NPI: 1508689324
Provider Name (Legal Business Name): PRESTO DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 04/16/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 GREYROCK PLACE
STAMFORD CT
06901
US

IV. Provider business mailing address

127 GREYROCK PL UNIT C-2
STAMFORD CT
06901-3100
US

V. Phone/Fax

Practice location:
  • Phone: 203-323-5439
  • Fax: 203-323-4445
Mailing address:
  • Phone: 203-343-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE DWYER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 973-578-8788