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General NPI Number Information
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NPI Number | 1588040687
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Entity Type | Organization
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Legal Business Name | JLG DENTAL LLC
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 85 NORTH ST
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City | DANBURY
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State | CT
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Zip | 06810-5635
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Country | US
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Telephone | 203-743-4770
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Fax |
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Provider Business Mailing Address
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Address Line | 2 STONY HILL RD STE 101
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City | BETHEL
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State | CT
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Zip | 06801-1045
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Country | US
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Telephone | 203-743-4770
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Fax |
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Authorized Official
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Title or Position | VP INSURANCE PLAN MANAGEMENT
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Name | MIKE J COLE
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Credential |
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Telephone | 727-424-2990
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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 | 5239
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License Number State | CT
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