Healthcare Provider Details

I. General information

NPI: 1679652143
Provider Name (Legal Business Name): TEPNEL LIFECODES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WEST AVE
STAMFORD CT
06902-6342
US

IV. Provider business mailing address

550 WEST AVE
STAMFORD CT
06902-6342
US

V. Phone/Fax

Practice location:
  • Phone: 203-328-9526
  • Fax: 203-328-9599
Mailing address:
  • Phone: 203-328-9526
  • Fax: 203-328-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY C. DAVIS
Title or Position: VICE PRESIDENT & GENERAL MANAGER
Credential: PH.D.
Phone: 203-328-9526