Provider Demographics
NPI:1083256226
Name:CONNECTICUT DENTAL PROFESSIONALS, P.C.
Entity Type:Organization
Organization Name:CONNECTICUT DENTAL PROFESSIONALS, P.C.
Other - Org Name:QUARRY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5699
Mailing Address - Street 1:276 OXFORD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1956
Mailing Address - Country:US
Mailing Address - Phone:203-463-4309
Mailing Address - Fax:203-828-6449
Practice Address - Street 1:276 OXFORD RD STE 2
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1956
Practice Address - Country:US
Practice Address - Phone:203-684-5808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONNECTICUT DENTAL PROFESSIONALS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-09
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty