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General NPI Number Information
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NPI Number | 1043420441
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Entity Type | Organization
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Legal Business Name | CENTER FOR ESTHETIC AND RESTORATIVE DENTISTRY, LLC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 47 CLAPBOARD HILL RD STE 3
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City | GUILFORD
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State | CT
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Zip | 06437-2282
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Country | US
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Telephone | 203-458-1992
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Fax |
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Provider Business Mailing Address
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Address Line | 47 CLAPBOARD HILL RD STE 3
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City | GUILFORD
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State | CT
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Zip | 06437-2282
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JAMES HEISE
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Credential | D.D.S.
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Telephone | 203-458-1992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7630
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License Number State | CT
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