Healthcare Provider Details

I. General information

NPI: 1497749550
Provider Name (Legal Business Name): MICHAEL A ERNEST DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CENTER ST
TORRINGTON CT
06790-5503
US

IV. Provider business mailing address

9 CENTER ST
TORRINGTON CT
06790-5503
US

V. Phone/Fax

Practice location:
  • Phone: 860-482-2199
  • Fax: 860-489-5053
Mailing address:
  • Phone: 860-482-2199
  • Fax: 860-489-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5033
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: