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General NPI Number Information
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NPI Number | 1053795070
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Entity Type | Organization
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Legal Business Name | ORANGE CENTER DENTISTRY PC
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 676 NEW HAVEN AVE SUITE A-3
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City | DERBY
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State | CT
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Zip | 06418-2500
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Country | US
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Telephone | 475-777-5108
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Fax | 475-777-5118
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Provider Business Mailing Address
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Address Line | 676 NEW HAVEN AVE SUITE A-3
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City | DERBY
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State | CT
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Zip | 06418-2500
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Country | US
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Telephone | 475-777-5108
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Fax | 475-777-5118
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER C. COGGUILLO
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Credential | DDS
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Telephone | 475-777-5108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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