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General NPI Number Information
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NPI Number | 1588728851
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Entity Type | Organization
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Legal Business Name | GLADSTEIN DENTAL CENTER LLC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 70 VINE ST
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City | NEW BRITAIN
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State | CT
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Zip | 06052-1431
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Country | US
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Telephone | 860-223-1162
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Fax | 860-224-9215
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Provider Business Mailing Address
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Address Line | 70 VINE ST
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City | NEW BRITAIN
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State | CT
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Zip | 06052-1431
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Country | US
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Telephone | 860-223-1162
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Fax | 860-224-9215
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Authorized Official
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Title or Position | MANAGER
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Name | MISS ERIC L. GLADSTEIN
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Credential | D.M.D.
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Telephone | 860-223-1162
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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 | 6349
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License Number State | CT
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