1033878079 NPI number — KILLINGLY KIDS DENTIST

Table of content: ALICIA CARLETTE MOORE NCC, LPC, CI (NPI 1356727572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033878079 NPI number — KILLINGLY KIDS DENTIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KILLINGLY KIDS DENTIST
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:
1033878079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 WILLOW WOODS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01545-6043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-932-6110
Provider Business Mailing Address Fax Number:
860-932-6113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KILLINGLY KIDS DENTIST
Provider Second Line Business Practice Location Address:
559 HARTFORD PIKE, SUITE C
Provider Business Practice Location Address City Name:
DAYVILLE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06241-0154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-306-1270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2021

Additional Information

Authorized Official

Authorized Official Last Name:
AHLUWALIA
Authorized Official First Name:
GURSIMRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-306-1270

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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