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General NPI Number Information
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NPI Number | 1457739765
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Entity Type | Organization
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Legal Business Name | ELITE FAMILY DENTISTRY
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 3579B BERLIN TPKE
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City | NEWINGTON
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State | CT
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Zip | 06111-5136
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Country | US
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Telephone | 860-266-4766
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Fax |
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Provider Business Mailing Address
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Address Line | 3579B BERLIN TPKE
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City | NEWINGTON
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State | CT
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Zip | 06111-5136
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Country | US
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Telephone | 860-266-4766
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANJITHA MUKUND
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Credential | DMD
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Telephone | 347-205-4040
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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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