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General NPI Number Information
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NPI Number | 1083749972
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE DENTISTRY
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 710 BRANCHVILLE RD
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City | RIDGEFIELD
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State | CT
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Zip | 06877
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Country | US
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Telephone | 203-544-8771
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Fax | 203-544-1036
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Provider Business Mailing Address
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Address Line | 710 BRANCHVILLE RD
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City | RIDGEFIELD
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State | CT
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Zip | 06877
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Country | US
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Telephone | 203-544-8771
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Fax | 203-544-1036
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Authorized Official
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Title or Position | PARTNER
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Name | DR. STEPHEN M MOLINANO
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Credential | DDS
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Telephone | 203-544-8771
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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 | 007961
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License Number State | CT
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