Healthcare Provider Details

I. General information

NPI: 1871668731
Provider Name (Legal Business Name): NEW ENGLAND DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 LAMBERTON RD
WINDSOR CT
06095-2129
US

IV. Provider business mailing address

250 LAMBERTON RD
WINDSOR CT
06095-2129
US

V. Phone/Fax

Practice location:
  • Phone: 860-688-3663
  • Fax: 860-688-2111
Mailing address:
  • Phone: 860-688-3663
  • Fax: 860-688-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7530
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5324
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6880
License Number StateCT

VIII. Authorized Official

Name: DR. STUART S FURMAN
Title or Position: PARTNER
Credential: D.M.D.
Phone: 860-688-3663