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General NPI Number Information
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NPI Number | 1801197298
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Entity Type | Organization
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Legal Business Name | HARTFORD DENTAL INCORPORATED
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 740 N MAIN ST
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2480
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Country | US
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Telephone | 860-233-4400
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Fax | 860-233-4408
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Provider Business Mailing Address
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Address Line | 740 N MAIN ST
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2480
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Country | US
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Telephone | 860-233-4400
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Fax | 860-233-4408
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE HAAS
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Credential | DMD
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Telephone | 860-233-4400
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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 | 008810
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License Number State | CT
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