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General NPI Number Information
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NPI Number | 1265863518
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Entity Type | Organization
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Legal Business Name | ADDISON VILLAGE DENTAL, INC
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 969 HEBRON AVE
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City | GLASTONBURY
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State | CT
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Zip | 06033-5033
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Country | US
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Telephone | 646-752-2005
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Fax |
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Provider Business Mailing Address
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Address Line | 969 HEBRON AVE
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City | GLASTONBURY
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State | CT
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Zip | 06033-5033
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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 | PRESIDENT
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Name | DR. GABRIELA VATAFU
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Credential |
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Telephone | 646-752-2005
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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 | 009515
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License Number State | CT
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