1003984824 NPI number — TORRINGTON DENTAL CARE PC

Table of content: (NPI 1003984824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003984824 NPI number — TORRINGTON DENTAL CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TORRINGTON DENTAL CARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GARBUS DAVISON & SHERMAN PC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003984824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 KENNEDY DR
Provider Second Line Business Mailing Address:
SUITE L105
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06790-3060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-489-8940
Provider Business Mailing Address Fax Number:
860-489-4346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 KENNEDY DR
Provider Second Line Business Practice Location Address:
SUITE L105
Provider Business Practice Location Address City Name:
TORRINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06790-3060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-489-8940
Provider Business Practice Location Address Fax Number:
860-489-4346
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUZMIN
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VP & SEC
Authorized Official Telephone Number:
860-489-8940

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4411 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 8102 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 020008102CT02 . This is a "ANTHEM BCBS OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1650034 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020004411CT01 . This is a "ANTHEM BCBS OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com