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General NPI Number Information
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NPI Number | 1922670819
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Entity Type | Organization
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Legal Business Name | GREENWICH DENTAL LLC
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 100 MELROSE AVE
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City | GREENWICH
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State | CT
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Zip | 06830-6257
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Country | US
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Telephone | 203-622-3068
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Fax | 203-622-3069
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Provider Business Mailing Address
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Address Line | 100 MELROSE AVE
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City | GREENWICH
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State | CT
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Zip | 06830-6257
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Country | US
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Telephone | 203-622-3068
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Fax | 203-622-3069
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUDITH CORDERO
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Credential | DDS
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Telephone | 203-622-3068
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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 |
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License Number State |
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