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General NPI Number Information
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NPI Number | 1194003046
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Entity Type | Organization
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Legal Business Name | WE CARE FAMILY DENTAL CENTER
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 1453 ALBANY AVE
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City | HARTFORD
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State | CT
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Zip | 06112-2110
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Country | US
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Telephone | 860-727-8146
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Fax | 860-241-0564
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Provider Business Mailing Address
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Address Line | 1453 ALBANY AVE
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City | HARTFORD
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State | CT
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Zip | 06112-2110
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Country | US
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Telephone | 860-727-8146
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Fax | 860-241-0564
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. EMMETT ETON WILSON
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Credential | D.D.S.
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Telephone | 860-727-8146
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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 | 010493
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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 | 5498
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License Number State | CT
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Taxonomy #3
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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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