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General NPI Number Information
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NPI Number | 1407572605
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Entity Type | Organization
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Legal Business Name | NEW ENGLAND ENDODONTICS PC
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 360 TOLLAND TPKE STE 2A
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City | MANCHESTER
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State | CT
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Zip | 06042-1770
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Country | US
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Telephone | 860-646-4811
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Fax |
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Provider Business Mailing Address
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Address Line | 66 DWIGHT RD STE 4
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City | LONGMEADOW
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State | MA
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Zip | 01106-1949
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Country | US
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Telephone | 413-565-2733
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING ADMINISTRATOR
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Name | LEAH ANN MAYLOTT
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Credential |
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Telephone | 860-874-8198
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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