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General NPI Number Information
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NPI Number | 1164567111
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL PRACTICE OF NEWINGTON
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 375 WILLARD AVE
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City | NEWINGTON
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State | CT
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Zip | 06111-2300
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Country | US
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Telephone | 860-665-0444
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Fax | 860-665-1465
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Provider Business Mailing Address
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Address Line | 375 WILLARD AVE
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City | NEWINGTON
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State | CT
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Zip | 06111-2300
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Country | US
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Telephone | 860-665-0444
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Fax | 860-665-1465
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. LYNN MICHELINE ALMEIDA
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Credential |
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Telephone | 860-665-0444
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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 | 4731
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5832
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 5407
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License Number State | CT
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