Provider Demographics
NPI:1033282306
Name:CHILD & ADULT ORTHODONTICS PC
Entity Type:Organization
Organization Name:CHILD & ADULT ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:BURZIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-669-1616
Mailing Address - Street 1:248 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413
Mailing Address - Country:US
Mailing Address - Phone:860-669-1616
Mailing Address - Fax:860-669-4525
Practice Address - Street 1:248 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413
Practice Address - Country:US
Practice Address - Phone:860-669-1616
Practice Address - Fax:860-669-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty