Healthcare Provider Details

I. General information

NPI: 1437294501
Provider Name (Legal Business Name): VALLEY DENTAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 FARMS VILLAGE RD
WEST SIMSBURY CT
06092-0266
US

IV. Provider business mailing address

PO BOX 266 240 FARMS VILLAGE RD
WEST SIMSBURY CT
06092-0266
US

V. Phone/Fax

Practice location:
  • Phone: 860-651-3541
  • Fax:
Mailing address:
  • Phone: 860-651-3541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4308
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5957
License Number StateCT

VIII. Authorized Official

Name: DR. KENNETH R FINN
Title or Position: MEMBER
Credential: DMD
Phone: 860-651-3541