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General NPI Number Information
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NPI Number | 1154960243
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Entity Type | Organization
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Legal Business Name | CONTEMPORARY GENERAL DENTISTRY, LLC
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 836 FARMINGTON AVE STE 215
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1544
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Country | US
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Telephone | 860-236-8000
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Fax | 860-236-9205
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Provider Business Mailing Address
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Address Line | 836 FARMINGTON AVE STE 215
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1544
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Country | US
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Telephone | 860-236-8000
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Fax | 860-236-9205
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TANYA NGUYEN
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Credential |
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Telephone | 860-236-8000
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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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