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General NPI Number Information
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NPI Number | 1861609646
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Entity Type | Organization
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Legal Business Name | NICHOLAS J BORRELLO DDS PC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 76 STONY HILL RD
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City | BETHEL
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State | CT
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Zip | 06801-3037
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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 | STONY HILL DENTAL CARE 76 STONY HILL ROAD
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City | BETHEL
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State | CT
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Zip | 06801-3037
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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 | OWNER
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Name | DR. NICHOLAS J BORRELLO
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Credential | DDS
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 003634
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License Number State | CT
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