Healthcare Provider Details

I. General information

NPI: 1023130705
Provider Name (Legal Business Name): STEVEN J ABBOTT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 STORRS RD
STORRS CT
06268
US

IV. Provider business mailing address

1733 STORRS RD STORRS ENDODONTICS LLC
STORRS CT
06268
US

V. Phone/Fax

Practice location:
  • Phone: 860-429-2051
  • Fax: 860-429-2053
Mailing address:
  • Phone: 860-429-2051
  • Fax: 860-429-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number008118
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: