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General NPI Number Information
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NPI Number | 1407698871
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Entity Type | Organization
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Legal Business Name | NEW BRITAIN PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 70 W MAIN ST STE 207
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City | NEW BRITAIN
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State | CT
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Zip | 06051-4224
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Country | US
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Telephone | 860-223-7044
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Fax |
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Provider Business Mailing Address
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Address Line | 697 POQUONOCK AVE
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City | WINDSOR
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State | CT
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Zip | 06095-2249
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Country | US
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Telephone | 860-751-2470
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | KADEEM BARTLEY
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Credential | DMD
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Telephone | 860-751-2470
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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