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General NPI Number Information
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NPI Number | 1679960280
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Entity Type | Organization
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Legal Business Name | ELITE DENTAL CARE
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 24 GRASSY PLAIN ST
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City | BETHEL
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State | CT
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Zip | 06801-1700
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Country | US
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Telephone | 203-616-5786
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Fax |
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Provider Business Mailing Address
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Address Line | 24 GRASSY PLAIN ST
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City | BETHEL
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State | CT
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Zip | 06801-1700
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Country | US
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Telephone | 203-616-5786
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUJATA PRADHAN-PECK
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Credential |
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Telephone | 203-616-5786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 010774
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License Number State | CT
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