Healthcare Provider Details

I. General information

NPI: 1730547605
Provider Name (Legal Business Name): ADVANCED VALLEY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 FARMS VILLAGE ROAD
WEST SIMSBURY CT
06092
US

IV. Provider business mailing address

240 FARMS VILLAGE RD P O BOX 266
WEST SIMSBURY CT
06092-2407
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 TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BEENISH ORR
Title or Position: OWNER
Credential: D.M.D
Phone: 860-651-3541