Healthcare Provider Details

I. General information

NPI: 1467675876
Provider Name (Legal Business Name): STORRS ENDODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 STORRS ROAD
STORRS CT
06268
US

IV. Provider business mailing address

1733 STORRS ROAD
STORRS CT
06268
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEVEN J ABBOTT
Title or Position: MEMBER
Credential: DMD
Phone: 860-429-2051