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General NPI Number Information
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NPI Number | 1932276540
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Entity Type | Organization
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Legal Business Name | FARMINGTON DENTAL ASSOCIATES
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 775 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06032-2310
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Country | US
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Telephone | 860-677-2226
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Fax | 860-678-8207
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Provider Business Mailing Address
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Address Line | 775 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06032-2310
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Country | US
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Telephone | 860-677-2226
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Fax | 860-678-8207
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANTHONY A MANCINI
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Credential | DDS
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Telephone | 860-677-2226
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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 | 008726
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License Number State | CT
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