1861406639 NPI number — CAPITOL DENTAL ASSOCIATES, LLC

Table of content: (NPI 1861406639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861406639 NPI number — CAPITOL DENTAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL DENTAL ASSOCIATES, LLC
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:
Provider Other Organization Name Type Code:
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:
1861406639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 FINANCIAL PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06103-2608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-247-5130
Provider Business Mailing Address Fax Number:
860-524-9000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 FINANCIAL PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06103-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-247-5130
Provider Business Practice Location Address Fax Number:
860-524-9000
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAROIAN
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
OWNER / DENTIST
Authorized Official Telephone Number:
860-247-5130

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com