Provider Demographics
NPI:1255825600
Name:PEOPLESDENTAL PC
Entity Type:Organization
Organization Name:PEOPLESDENTAL PC
Other - Org Name:ROSENBERG ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAYLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-874-8198
Mailing Address - Street 1:21 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1939
Mailing Address - Country:US
Mailing Address - Phone:860-874-8198
Mailing Address - Fax:508-986-7317
Practice Address - Street 1:21 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-236-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEOPLESDENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty