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General NPI Number Information
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NPI Number | 1407427347
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Entity Type | Organization
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Legal Business Name | IDENT DENTAL AT GREENWICH
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 75 HOLLY HILL LN
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City | GREENWICH
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State | CT
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Zip | 06830-6098
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Country | US
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Telephone | 203-548-0826
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Fax |
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Provider Business Mailing Address
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Address Line | 711 CANAL ST # 250
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City | STAMFORD
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State | CT
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Zip | 06902-6094
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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 | OPERATIONS DIRECTOR
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Name | ADAM SPOSATO
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Credential |
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Telephone | 646-208-1456
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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 |
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License Number State |
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