Provider Demographics
NPI:1235478686
Name:R.E. HOLDINGS, LLC
Entity Type:Organization
Organization Name:R.E. HOLDINGS, LLC
Other - Org Name:RELIABLE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:
Authorized Official - Last Name:POLVERARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-656-0798
Mailing Address - Street 1:835 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1315
Mailing Address - Country:US
Mailing Address - Phone:203-596-1960
Mailing Address - Fax:203-596-1998
Practice Address - Street 1:835 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1315
Practice Address - Country:US
Practice Address - Phone:203-596-1960
Practice Address - Fax:203-596-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0073751223G0001X
CT0109461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty