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General NPI Number Information
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NPI Number | 1487175782
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL SLEEP MEDICINE OF CONNECTICUT, PC
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 85 PRESCOTT ST STE 302
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City | WORCESTER
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State | MA
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Zip | 01605-2610
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Country | US
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Telephone | 844-557-1701
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Fax | 888-956-3939
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Provider Business Mailing Address
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Address Line | 2318 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06615-5966
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Country | US
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Telephone | 844-557-1701
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Fax | 888-956-3939
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Authorized Official
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Title or Position | PRESIDENT
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Name | REZA RADMAND
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Credential | DMD
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Telephone | 844-557-1701
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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 |
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License Number State |
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