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General NPI Number Information
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NPI Number | 1164877098
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Entity Type | Organization
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Legal Business Name | GRILLO DENTAL, L.L.C.
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 498 BUCKLAND RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3708
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Country | US
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Telephone | 860-648-2848
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Fax | 860-648-2893
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Provider Business Mailing Address
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Address Line | 498 BUCKLAND RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3708
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Country | US
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Telephone | 860-648-2848
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ZACHARY GRILLO
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Credential | D.M.D.
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Telephone | 860-648-2848
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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 | 5791
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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 | 010565
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License Number State | CT
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