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General NPI Number Information
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NPI Number | 1902294713
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Entity Type | Organization
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Legal Business Name | REGENCY FAMILY DENTAL
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Dates
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Enumeration Date | 12/31/2014
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 1 STRAWBERRY HILL CT
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City | STAMFORD
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State | CT
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Zip | 06902-2548
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Country | US
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Telephone | 203-323-1186
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Fax |
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Provider Business Mailing Address
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Address Line | 1 STRAWBERRY HILL CT
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City | STAMFORD
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State | CT
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Zip | 06902-2548
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Country | US
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Telephone | 203-323-1186
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADYA SHROTRIYA
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Credential |
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Telephone | 917-216-3377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9984
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License Number State | CT
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