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General NPI Number Information
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NPI Number | 1588915821
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Entity Type | Organization
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Legal Business Name | CANDLEWOOD DENTAL CARE INC
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 87 STATE ROUTE 39
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City | NEW FAIRFIELD
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State | CT
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Zip | 06812-4120
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Country | US
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Telephone | 203-746-1200
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Fax | 203-746-2315
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Provider Business Mailing Address
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Address Line | 87 STATE ROUTE 39
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City | NEW FAIRFIELD
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State | CT
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Zip | 06812-4120
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Country | US
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Telephone | 203-746-1200
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Fax | 203-746-2315
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | LORRAINE BURIO
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Credential | D.M.D.
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Telephone | 203-746-1200
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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 | 7208
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License Number State | CT
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