Provider Demographics
NPI:1114325925
Name:APEX DENTAL LLC
Entity Type:Organization
Organization Name:APEX DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:AVIRAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-263-8544
Mailing Address - Street 1:408 NEW BRITAIN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3832
Mailing Address - Country:US
Mailing Address - Phone:860-263-8544
Mailing Address - Fax:
Practice Address - Street 1:408 NEW BRITAIN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3832
Practice Address - Country:US
Practice Address - Phone:860-263-8544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008049638Medicaid