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General NPI Number Information
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NPI Number | 1194340828
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Entity Type | Organization
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Legal Business Name | MONROE FAMILY DENTISTRY
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 181 MAIN ST
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City | MONROE
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State | CT
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Zip | 06468-1110
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Country | US
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Telephone | 203-445-8365
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Fax |
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Provider Business Mailing Address
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Address Line | 115 FILLOW ST APT 4
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City | NORWALK
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State | CT
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Zip | 06850-2842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RAMAN GILL
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Credential | DDS
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Telephone | 917-239-8114
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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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