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General NPI Number Information
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NPI Number | 1851853618
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Entity Type | Organization
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Legal Business Name | STONY HILL DENTAL CARE PLLC
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 76 STONY HILL RD
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City | BETHEL
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State | CT
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Zip | 06801-3055
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Country | US
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Telephone | 203-744-0033
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Fax | 203-744-2118
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Provider Business Mailing Address
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Address Line | 76 STONY HILL RD
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City | BETHEL
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State | CT
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Zip | 06801-3055
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Country | US
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Telephone | 203-744-0033
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Fax | 203-744-2118
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | WALTER KOSTRZEWSKI
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Credential | DMD
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Telephone | 203-744-0033
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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 |
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License Number State |
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