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General NPI Number Information
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NPI Number | 1497857296
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Entity Type | Organization
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Legal Business Name | FARMINGTON VILLAGE DENTAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 320 MAIN ST
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City | FARMINGTON
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State | CT
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Zip | 06032-2961
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Country | US
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Telephone | 860-676-2288
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Fax | 860-676-2292
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Provider Business Mailing Address
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Address Line | 320 MAIN ST
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City | FARMINGTON
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State | CT
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Zip | 06032-2961
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Country | US
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Telephone | 860-676-2288
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Fax | 860-676-2292
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Authorized Official
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Title or Position | OWNER/MANAGING MEMEBER
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Name | DR. MONIQUE MARIE NADEAU
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Credential | DMD
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Telephone | 860-676-2288
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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 | 008586
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License Number State | CT
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