MEDICARE: CLOVE FAMILY DENTISTRY, INC

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

General Provider Information

NPI Number	:	1528841996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOVE FAMILY DENTISTRY, INC

Provider Business Mailing Address
First Line	:	201 TRAILS END RD APT 201
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-7108
Country	:	US
Telephone Number	:	585-545-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 LEXINGTON ST
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06052-1446
Country	:	US
Telephone Number	:	585-545-0090
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. SONAM HASIJA
Credential	:	DDS
Telephone Number	:	585-545-0090

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	08/17/2023

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Directions to “CLOVE FAMILY DENTISTRY, INC ” Practice Location

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