Provider Demographics
NPI:1073833992
Name:DENTAL ASSOCIATES OF SHELTON, LLP
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF SHELTON, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASERTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-924-4115
Mailing Address - Street 1:190 CORAM AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3347
Mailing Address - Country:US
Mailing Address - Phone:203-924-4115
Mailing Address - Fax:203-924-1301
Practice Address - Street 1:190 CORAM AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3347
Practice Address - Country:US
Practice Address - Phone:203-924-4115
Practice Address - Fax:203-924-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty