Provider Demographics
NPI:1376652958
Name:NIANTIC DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:NIANTIC DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLDSCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-739-3401
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-0503
Mailing Address - Country:US
Mailing Address - Phone:860-739-3401
Mailing Address - Fax:860-739-9750
Practice Address - Street 1:177 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1203
Practice Address - Country:US
Practice Address - Phone:860-739-3401
Practice Address - Fax:860-739-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty