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NPI Code Detail

MEDICARE: WILLOWS DENTAL ASSOCIATES, LLC

MEDICARE: WILLOWS DENTAL ASSOCIATES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry008400CT

General Provider Information

NPI Number : 1346442696
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLOWS DENTAL ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 127 KINGS HWY N
Second Line :
City : WESTPORT
State : CT
Zip : 06880-2422
Country : US
Telephone Number : 203-227-2377
Fax Number : 203-227-1682
Provider Business Practice Location Address
First Line : 127 KINGS HWY N
Second Line :
City : WESTPORT
State : CT
Zip : 06880-2422
Country : US
Telephone Number : 203-227-2377
Fax Number : 203-227-1682
Authorized Official
Title or Position : PARTNER
Name : DR. DAVID ALLEN INGBER
Credential : D.D.S.
Telephone Number : 203-227-2377
Provider Enumeration Date : 05/31/2007
Last Update Date : 08/22/2020

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Directions to “WILLOWS DENTAL ASSOCIATES, LLC ” Practice Location

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