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General NPI Number Information
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NPI Number | 1023725868
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Entity Type | Organization
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Legal Business Name | SPARRROW DENTISTRY
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Dates
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Enumeration Date | 11/01/2022
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 767 WOLCOTT ST STE 3
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City | WATERBURY
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State | CT
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Zip | 06705-1324
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Country | US
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Telephone | 919-593-3791
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Fax |
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Provider Business Mailing Address
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Address Line | 1 WADES LNDG
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City | NEW MILFORD
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State | CT
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Zip | 06776-2666
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Country | US
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Telephone | 919-593-3791
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | IKECHUKWU IHENATU
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Credential | DDS
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Telephone | 919-593-3791
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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 |
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License Number State |
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