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General NPI Number Information
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NPI Number | 1114234697
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Entity Type | Organization
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Legal Business Name | NUTMEG DENTAL, P.C.
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 1266 E MAIN ST STE 700R
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City | STAMFORD
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State | CT
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Zip | 06902-3550
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Country | US
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Telephone | 888-833-8441
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Fax | 888-330-4331
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Provider Business Mailing Address
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Address Line | 1266 EAST MAIN STREET, SUITE 700R
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City | STAMFORD
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State | CT
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Zip | 06902
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Country | US
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Telephone | 888-833-8441
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Fax | 888-330-4331
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | RONALD J. LINDEN
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Credential | DDS
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Telephone | 888-833-8441
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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 | 005405
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License Number State | CT
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