1144898503 NPI number — NEW ENGLAND ENDODONTICS PC

Table of content: (NPI 1144898503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144898503 NPI number — NEW ENGLAND ENDODONTICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ENGLAND ENDODONTICS 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:
STORRS ENDODONTICS & PERIODONTICS
Provider Other Organization Name Type Code:
3
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:
1144898503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 DWIGHT RD STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01106-1949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-565-2733
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1022 STORRS RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STORRS
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06268-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-429-2051
Provider Business Practice Location Address Fax Number:
860-429-2053
Provider Enumeration Date:
06/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MAYLOTT
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CREDENTIALING ADMINISTRATOR
Authorized Official Telephone Number:
860-874-8198

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X ; 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