Healthcare Provider Details

I. General information

NPI: 1801949250
Provider Name (Legal Business Name): DAWN COOLEY STEVENS D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MAIN ST
UNIONVILLE CT
06085-1118
US

IV. Provider business mailing address

36 MAIN ST
UNIONVILLE CT
06085-1118
US

V. Phone/Fax

Practice location:
  • Phone: 860-673-9770
  • Fax: 860-404-7728
Mailing address:
  • Phone: 860-673-9770
  • Fax: 860-404-7728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8027
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: