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General NPI Number Information
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NPI Number | 1942443726
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Entity Type | Organization
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Legal Business Name | OLD LYME DENTAL ASSOCIATES LLC
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 19 HALLS RD SUITE 218
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City | OLD LYME
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State | CT
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Zip | 06371-1457
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Country | US
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Telephone | 860-434-7378
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Fax | 860-434-7537
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Provider Business Mailing Address
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Address Line | PO BOX 551
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City | OLD LYME
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State | CT
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Zip | 06371-0551
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Country | US
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Telephone | 860-434-7378
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Fax | 860-434-7537
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | JEFFREY B LAMURA
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Credential | DDS
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Telephone | 860-434-7378
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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 | 9618
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9080
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9037
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License Number State | CT
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