Provider Demographics
NPI:1013037308
Name:NORTH BRANFORD DENTAL GROUP PC
Entity Type:Organization
Organization Name:NORTH BRANFORD DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:I
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-488-6343
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-0193
Mailing Address - Country:US
Mailing Address - Phone:203-488-6343
Mailing Address - Fax:203-488-6185
Practice Address - Street 1:337 NOTCH HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1826
Practice Address - Country:US
Practice Address - Phone:203-488-6343
Practice Address - Fax:203-488-6185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty