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General NPI Number Information
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NPI Number | 1780701961
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Entity Type | Organization
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Legal Business Name | MAIN STREET DENTAL, PC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 209 MAIN ST
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City | DANBURY
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State | CT
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Zip | 06810-2624
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Country | US
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Telephone | 203-730-2917
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Fax | 203-730-2927
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Provider Business Mailing Address
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Address Line | 209 MAIN ST
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City | DANBURY
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State | CT
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Zip | 06810-2624
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Country | US
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Telephone | 203-730-2917
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Fax | 203-730-2927
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARIA GERMANIA BERAS-VILLEGA
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Credential |
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Telephone | 203-730-2917
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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 | 008435
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License Number State | CT
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