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General NPI Number Information
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NPI Number | 1043707755
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Entity Type | Organization
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Legal Business Name | STONINGTON DENTAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 20 S ANGUILLA RD
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City | PAWCATUCK
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State | CT
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Zip | 06379-1447
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Country | US
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Telephone | 860-599-2505
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Fax |
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Provider Business Mailing Address
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Address Line | 20 S ANGUILLA RD
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City | PAWCATUCK
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State | CT
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Zip | 06379-1447
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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 | MANAGER
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Name | MS. AMANDA KIRWIN
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Credential |
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Telephone | 401-578-0274
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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 | 12125
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License Number State | CT
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