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General NPI Number Information
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NPI Number | 1255632667
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Entity Type | Organization
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Legal Business Name | KENNEDY FAMILY DENTAL
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 333 KENNEDY DR SUITE-L-102
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City | TORRINGTON
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State | CT
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Zip | 06790-3060
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Country | US
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Telephone | 860-496-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 333 KENNEDY DR SUITE-L-102
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City | TORRINGTON
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State | CT
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Zip | 06790-3060
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Country | US
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Telephone | 860-496-1200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RIDHIMA GOYAL
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Credential | DMD
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Telephone | 860-496-1200
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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 | 010154
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License Number State | CT
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