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General NPI Number Information
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NPI Number | 1942352059
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Entity Type | Organization
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Legal Business Name | CONNECTICUT ENDODONTIC ASSOCIATES P.C.
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 360 TOLLAND TPKE SUITE2A
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City | MANCHESTER
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State | CT
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Zip | 06042-1771
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Country | US
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Telephone | 860-646-4811
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Fax | 860-645-0882
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Provider Business Mailing Address
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Address Line | 360 TOLLAND TPKE SUITE2A
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City | MANCHESTER
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State | CT
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Zip | 06042-1771
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Country | US
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Telephone | 860-646-4811
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Fax | 860-645-0882
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. STEPHEN RUDOLPH QUATROCELLI
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Credential | D.M.D.
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Telephone | 860-646-4811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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