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General NPI Number Information
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NPI Number | 1235608720
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Entity Type | Organization
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Legal Business Name | NEWINGTON DENTAL CARE PLLC
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 112 MARKET SQ
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City | NEWINGTON
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State | CT
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Zip | 06111-2913
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Country | US
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Telephone | 860-667-2600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 67
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City | LATHAM
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State | NY
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Zip | 12110-0067
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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 | OPERATIONS
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Name | DARIA RENEE GAGLIARDI
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Credential |
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Telephone | 518-275-2988
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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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