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General NPI Number Information
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NPI Number | 1235621764
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Entity Type | Organization
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Legal Business Name | C&S FAMILY DENTAL NEW BRITAIN
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 705 FARMINGTON AVE
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City | NEW BRITAIN
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State | CT
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Zip | 06053-1657
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Country | US
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Telephone | 860-293-2000
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Fax | 860-293-2007
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Provider Business Mailing Address
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Address Line | 705 FARMINGTON AVE
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City | NEW BRITAIN
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State | CT
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Zip | 06053-1657
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Country | US
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Telephone | 860-293-2000
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Fax | 860-293-2007
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Authorized Official
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Title or Position | MEMBER
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Name | BOHUN CHOI
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Credential | DDS
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Telephone | 860-293-2000
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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 | 11234
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License Number State | CT
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