Provider Demographics
NPI:1093406860
Name:QUINNIPIAC ENDO CT PC
Entity Type:Organization
Organization Name:QUINNIPIAC ENDO CT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ARTURO
Authorized Official - Last Name:SATO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:860-424-7818
Mailing Address - Street 1:102 HILLSIDE LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-3309
Mailing Address - Country:US
Mailing Address - Phone:860-424-7818
Mailing Address - Fax:
Practice Address - Street 1:850 N MAIN STREET EXT STE D3
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2400
Practice Address - Country:US
Practice Address - Phone:203-284-9945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty