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General NPI Number Information
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NPI Number | 1396103255
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Entity Type | Organization
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Legal Business Name | BRANFORD DENTAL GROUP, LLC
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 1100 BARNUM AVE
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City | STRATFORD
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State | CT
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Zip | 06614
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Country | US
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Telephone | 203-864-3430
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Fax | 203-378-2759
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Provider Business Mailing Address
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Address Line | 1060 WEST MAIN STREET
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City | BRANDFORD
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State | CT
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Zip | 06405
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Country | US
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Telephone | 203-864-3430
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Fax | 203-378-2759
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Authorized Official
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Title or Position | OWNER
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Name | DR. DHARAM P TAYAL
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Credential | DDS
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Telephone | 203-864-3430
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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 | 010878
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License Number State | CT
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