Provider Demographics
NPI:1275934051
Name:WESTERN CONNECTICUT DENTAL ARTS
Entity Type:Organization
Organization Name:WESTERN CONNECTICUT DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-350-9232
Mailing Address - Street 1:120 PARK LANE RD
Mailing Address - Street 2:UNIT B201
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2444
Mailing Address - Country:US
Mailing Address - Phone:860-350-9232
Mailing Address - Fax:860-355-9232
Practice Address - Street 1:120 PARK LANE RD
Practice Address - Street 2:UNIT B201
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2444
Practice Address - Country:US
Practice Address - Phone:860-350-9232
Practice Address - Fax:860-355-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0098251223G0001X
CT0062191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty