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General NPI Number Information
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NPI Number | 1467674820
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Entity Type | Organization
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Legal Business Name | MANSFIELD CT DENTAL PLLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 10 HIGGINS HWY STE 1
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1437
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Country | US
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Telephone | 860-456-2906
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Fax |
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Provider Business Mailing Address
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Address Line | 10 HIGGINS HWY STE 1
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1437
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Country | US
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Telephone | 860-456-2906
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. JANIS LAURIE CZARNOWSKI
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Credential | RDH
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Telephone | 860-456-2906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6334
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6192
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License Number State | CT
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