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General NPI Number Information
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NPI Number | 1932246964
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Entity Type | Organization
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Legal Business Name | THE ELMWOOD DENTAL GROUP, LLC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 1132 NEW BRITAIN AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06110-2413
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Country | US
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Telephone | 860-236-6928
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Fax | 860-236-6920
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Provider Business Mailing Address
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Address Line | 1132 NEW BRITAIN AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06110-2413
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Country | US
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Telephone | 860-236-6928
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Fax | 860-236-6920
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ANA PAULA GOMES
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Credential | DMD
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Telephone | 860-236-6928
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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 | 8560
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License Number State | CT
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