Provider Demographics
NPI:1366653933
Name:SALVATORE JAMES SQUATRITO JR DDS PC
Entity Type:Organization
Organization Name:SALVATORE JAMES SQUATRITO JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PROFESSIONAL CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SQUATRITO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-646-1429
Mailing Address - Street 1:360 TOLLAND TURNPIKE
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1759
Mailing Address - Country:US
Mailing Address - Phone:860-646-1429
Mailing Address - Fax:860-646-6897
Practice Address - Street 1:360 TOLLAND TURNPIKE
Practice Address - Street 2:SUITE 1-C
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1759
Practice Address - Country:US
Practice Address - Phone:860-646-1429
Practice Address - Fax:860-646-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0039461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty