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General NPI Number Information
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NPI Number | 1831878487
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Entity Type | Organization
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Legal Business Name | FARMINGTON 1067 LLC
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 1067 FARMINGTON AVE
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City | BERLIN
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State | CT
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Zip | 06037-2244
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Country | US
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Telephone | 860-438-6696
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Fax |
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Provider Business Mailing Address
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Address Line | 1067 FARMINGTON AVE
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City | BERLIN
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State | CT
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Zip | 06037-2244
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Country | US
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Telephone | 860-438-6696
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HISAKO SEIGNEMARTIN
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Credential | DDS
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Telephone | 860-438-6696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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