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General NPI Number Information
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NPI Number | 1366653933
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Entity Type | Organization
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Legal Business Name | SALVATORE JAMES SQUATRITO JR DDS PC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 360 TOLLAND TURNPIKE SUITE 1-C
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City | MANCHESTER
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State | CT
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Zip | 06042-1759
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Country | US
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Telephone | 860-646-1429
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Fax | 860-646-6897
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Provider Business Mailing Address
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Address Line | 360 TOLLAND TURNPIKE SUITE 1-C
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City | MANCHESTER
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State | CT
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Zip | 06042-1759
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Country | US
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Telephone | 860-646-1429
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Fax | 860-646-6897
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Authorized Official
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Title or Position | PRESIDENT PROFESSIONAL CORPORATION
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Name | DR. SALVATORE JAMES SQUATRITO JR.
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Credential | DDS
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Telephone | 860-646-1429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 003946
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License Number State | CT
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