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General NPI Number Information
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NPI Number | 1740092030
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Entity Type | Organization
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Legal Business Name | BLUE SKY DENTAL PLLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 530 HOPMEADOW ST STE 110
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City | SIMSBURY
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State | CT
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Zip | 06070-2415
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Country | US
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Telephone | 860-658-9889
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Fax |
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Provider Business Mailing Address
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Address Line | 21 BRUCE LN
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City | AVON
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State | CT
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Zip | 06001-3502
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Country | US
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Telephone | 786-294-2769
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FRANCISCO JAVIER SUAREZ ESSER
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Credential | DDS
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Telephone | 786-294-2769
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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 |
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License Number State |
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