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General NPI Number Information
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NPI Number | 1538554647
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Entity Type | Organization
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Legal Business Name | FAMILY & PREVENTIVE DENTISTRY, PC
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 357 MAIN ST S
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City | WOODBURY
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State | CT
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Zip | 06798-3408
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Country | US
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Telephone | 203-263-5575
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Fax |
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Provider Business Mailing Address
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Address Line | 357 MAIN ST S PO BOX 593
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City | WOODBURY
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State | CT
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Zip | 06798-3408
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Country | US
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Telephone | 203-263-5575
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JAMES B. MARSHALL
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Credential | DMD
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Telephone | 203-263-5575
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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 | 7617
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License Number State | CT
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