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General NPI Number Information
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NPI Number | 1164159430
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Entity Type | Organization
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Legal Business Name | LITCHFIELD CENTER DENTAL PC
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 3 WEST ST
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City | LITCHFIELD
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State | CT
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Zip | 06759-3501
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Country | US
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Telephone | 860-567-5502
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60
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City | LITCHFIELD
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State | CT
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Zip | 06759-0060
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Country | US
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Telephone | 860-567-5502
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | WONJOON CHOI
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Credential |
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Telephone | 860-567-5502
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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 |
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License Number State |
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