Provider Demographics
NPI:1053305201
Name:CONFORTI, PHILIP J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:CONFORTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2723
Mailing Address - Country:US
Mailing Address - Phone:203-453-4381
Mailing Address - Fax:203-458-5085
Practice Address - Street 1:2560 DIXWELL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1852
Practice Address - Country:US
Practice Address - Phone:203-281-3737
Practice Address - Fax:203-230-2931
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U20696Medicare UPIN
CT190000997Medicare PIN