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General NPI Number Information
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NPI Number | 1164446720
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Entity Type | Organization
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Legal Business Name | ENDODONTIC ASSOCIATES OF NORWALK
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 EAST AVE
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City | NORWALK
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State | CT
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Zip | 06851-5703
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Country | US
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Telephone | 203-853-0880
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Fax | 203-866-3522
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Provider Business Mailing Address
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Address Line | 120 EAST AVE
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City | NORWALK
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State | CT
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Zip | 06851-5703
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Country | US
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Telephone | 203-853-0880
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Fax | 203-866-3522
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CAROL GAVRIELIDIS
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Credential |
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Telephone | 203-853-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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