1811393226 NPI number — SHARON DENTAL ASSOCIATES LLC

Table of content: JOSEPH ALEXANDER WIENER MD (NPI 1063901825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811393226 NPI number — SHARON DENTAL ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON 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:
1811393226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06069-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-364-0204
Provider Business Mailing Address Fax Number:
860-364-0505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06069-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-364-0204
Provider Business Practice Location Address Fax Number:
860-364-0505
Provider Enumeration Date:
11/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
COLITE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
860-364-0204

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  10168 , 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)

  • Identifier: 1962630632 . This is a "PERSONAL NPI #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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