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General NPI Number Information
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NPI Number | 1396289195
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Entity Type | Organization
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Legal Business Name | DEMAS ORTHODONTICS PC
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 27 MERIDEN AVE STE 2A
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City | SOUTHINGTON
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State | CT
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Zip | 06489-3234
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Country | US
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Telephone | 860-276-0333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 522
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City | WATERTOWN
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State | CT
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Zip | 06795-0522
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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 | DONALD DEMAS
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Credential | DDS
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Telephone | 860-276-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 006708
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License Number State | CT
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