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General NPI Number Information
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NPI Number | 1023530441
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Entity Type | Organization
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Legal Business Name | C&S DENTAL CARE LLC
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 456 PARK ST
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City | HARTFORD
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State | CT
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Zip | 06106-1525
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Country | US
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Telephone | 860-293-2000
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Fax | 860-293-2007
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Provider Business Mailing Address
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Address Line | 456 PARK ST
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City | HARTFORD
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State | CT
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Zip | 06106-1525
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Country | US
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Telephone | 860-293-2000
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Fax | 860-293-2007
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Authorized Official
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Title or Position | DDS
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Name | BOHUN CHOI
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Credential |
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Telephone | 585-732-1994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 011234
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License Number State | CT
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