MEDICARE: NEW BRITAIN PEDIATRIC DENTISTRY PLLC

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
1	1223G0001X	General Practice Dentistry
2	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1407698871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BRITAIN PEDIATRIC DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	697 POQUONOCK AVE
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-2249
Country	:	US
Telephone Number	:	860-751-2470
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 W MAIN ST STE 207
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06051-4224
Country	:	US
Telephone Number	:	860-223-7044
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	KADEEM BARTLEY
Credential	:	DMD
Telephone Number	:	860-751-2470

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	06/07/2024

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