Provider Demographics
NPI:1174020630
Name:HOME TOWN DENTAL INC
Entity Type:Organization
Organization Name:HOME TOWN DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RITZCOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-203-3795
Mailing Address - Street 1:31 BAILEY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4533
Mailing Address - Country:US
Mailing Address - Phone:212-203-3795
Mailing Address - Fax:
Practice Address - Street 1:31 BAILEY AVE STE C
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4533
Practice Address - Country:US
Practice Address - Phone:212-203-3795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty