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General NPI Number Information
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NPI Number | 1972339927
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Entity Type | Organization
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Legal Business Name | ELMWOOD AND MAIN DENTISTRY LLC
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 105 MAIN ST UNIT 1
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-2393
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Country | US
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Telephone | 321-591-4571
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Fax |
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Provider Business Mailing Address
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Address Line | 93 HARBOR AVE
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City | MADISON
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State | CT
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Zip | 06443-2824
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. DEREK CHENET
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Credential | DDS
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Telephone | 321-591-4571
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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 |
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License Number State |
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