1114292323 NPI number — LINCOLN COLLEGE OF NEW ENGLAND DENTAL HYGIENE CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114292323 NPI number — LINCOLN COLLEGE OF NEW ENGLAND DENTAL HYGIENE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN COLLEGE OF NEW ENGLAND DENTAL HYGIENE CLINIC
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:
1114292323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2279 MOUNT VERNON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06489-1007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-426-0467
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2279 MOUNT VERNON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06489-1007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-426-0467
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RYAN
Authorized Official First Name:
ROSEMARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIR OF DENTAL STUDIES
Authorized Official Telephone Number:
860-628-4751

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  003706 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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