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General NPI Number Information
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NPI Number | 1205563822
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Entity Type | Organization
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Legal Business Name | DENTAL VISION,PC
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 115 NEW HAVEN AVE
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City | DERBY
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State | CT
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Zip | 06418-2154
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Country | US
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Telephone | 203-751-9667
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Fax |
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Provider Business Mailing Address
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Address Line | 115 NEW HAVEN AVE
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City | DERBY
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State | CT
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Zip | 06418-2154
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Country | US
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Telephone | 347-323-1715
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TETYANA POHORLETSKA
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Credential | DDS
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Telephone | 347-323-1715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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