Provider Demographics
NPI:1235474388
Name:GLOBUS DENTAL ASSOCIATES MANCHESTER, PC
Entity Type:Organization
Organization Name:GLOBUS DENTAL ASSOCIATES MANCHESTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAYAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRUMAMILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-644-5400
Mailing Address - Street 1:1540 PLEASANT VALLEY RD STE G
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-8760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1540 PLEASANT VALLEY RD STE G
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8760
Practice Address - Country:US
Practice Address - Phone:860-644-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty