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General NPI Number Information
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NPI Number | 1841306883
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN PERIODONTICS, PC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 281 HARTFORD TPKE SUITE 202
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City | VERNON
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State | CT
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Zip | 06066-4784
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Country | US
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Telephone | 860-871-1311
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Fax | 860-875-7315
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Provider Business Mailing Address
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Address Line | 281 HARTFORD TPKE SUITE 202
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City | VERNON
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State | CT
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Zip | 06066-4784
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Country | US
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Telephone | 860-871-1311
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Fax | 860-875-7315
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. ROBERT A. KIEL
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Credential | D.M.D.
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Telephone | 860-871-1311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 5585
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License Number State | CT
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