Healthcare Provider Details

I. General information

NPI: 1144221789
Provider Name (Legal Business Name): EPSTEIN & RAPOPORT P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N MAIN ST SUITE 320
WEST HARTFORD CT
06117-2515
US

IV. Provider business mailing address

345 N MAIN ST SUITE 320
WEST HARTFORD CT
06117-2515
US

V. Phone/Fax

Practice location:
  • Phone: 860-523-4213
  • Fax: 860-523-1106
Mailing address:
  • Phone: 860-523-4213
  • Fax: 860-523-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4316
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4572
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5564
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7726
License Number StateCT

VIII. Authorized Official

Name: DAVID W EPSTEIN
Title or Position: PARTNER/DENTIST
Credential: D.D.S.
Phone: 860-523-4213