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General NPI Number Information
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NPI Number | 1417389636
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Entity Type | Organization
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Legal Business Name | HOSPITAL DENTAL GROUP DDS PC
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 85 SEYMOUR ST SUITE 922
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City | HARTFORD
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State | CT
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Zip | 06106-5501
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Country | US
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Telephone | 860-524-5194
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Fax | 860-349-4571
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Provider Business Mailing Address
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Address Line | 85 SEYMOUR ST SUITE 922
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City | HARTFORD
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State | CT
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Zip | 06106-5501
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Country | US
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Telephone | 860-524-5194
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Fax | 860-349-4571
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANATOLIY RAVIN
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Credential | DDS
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Telephone | 860-524-5194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 008890
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License Number State | CT
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