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General NPI Number Information
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NPI Number | 1689107534
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Entity Type | Organization
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Legal Business Name | PENTA DENTAL LC
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 1100 BARNUM AVE
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City | STRATFORD
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State | CT
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Zip | 06614-4901
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Country | US
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Telephone | 716-239-5889
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 BARNUM AVE
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City | STRATFORD
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State | CT
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Zip | 06614-4901
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Country | US
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Telephone | 716-239-5889
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DHARAM TAYAL
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Credential | DDS
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Telephone | 716-239-5889
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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 | 010878
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License Number State | CT
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