Healthcare Provider Details

I. General information

NPI: 1124132600
Provider Name (Legal Business Name): WINFIELD S DANIELSON JR DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 TOLLAND STAGE RD
TOLLAND CT
06084-0864
US

IV. Provider business mailing address

PO BOX 864
TOLLAND CT
06084-0864
US

V. Phone/Fax

Practice location:
  • Phone: 860-871-2875
  • Fax: 860-871-2875
Mailing address:
  • Phone: 860-871-2875
  • Fax: 860-871-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3640
License Number StateCT

VIII. Authorized Official

Name: DR. WILLIAM L DANIELSON JR.
Title or Position: OWNER
Credential: DDS
Phone: 860-871-2875