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General NPI Number Information
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NPI Number | 1982834529
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Entity Type | Individual
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Provider Name | AVINASH S BIDRA BDS, MS, FACP
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Gender | Male
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 300 HEBRON AVE STE 112
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City | GLASTONBURY
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State | CT
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Zip | 06033-2176
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Country | US
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Telephone | 860-659-8660
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Fax | 860-633-6229
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Provider Business Mailing Address
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Address Line | 300 HEBRON AVE STE 112
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City | GLASTONBURY
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State | CT
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Zip | 06033-2176
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Country | US
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Telephone | 860-659-8660
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Fax | 860-633-6229
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 010160
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License Number State | CT
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