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General NPI Number Information
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NPI Number | 1952894743
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Entity Type | Organization
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Legal Business Name | WILTON PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 101 OLD RIDGEFIELD RD STE 103
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City | WILTON
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State | CT
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Zip | 06897-3047
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Country | US
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Telephone | 203-529-1242
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Fax |
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Provider Business Mailing Address
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Address Line | 101 OLD RIDGEFIELD RD STE 103
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City | WILTON
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State | CT
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Zip | 06897-3047
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Country | US
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Telephone | 203-529-1242
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ASHLEIGH SEBRO
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Credential | DDS
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Telephone | 203-529-1242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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