Provider Demographics
NPI:1427563956
Name:NEW LONDON FAMILY DENTISTRY & IMPLANTS
Entity Type:Organization
Organization Name:NEW LONDON FAMILY DENTISTRY & IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-444-9345
Mailing Address - Street 1:48 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-3414
Mailing Address - Country:US
Mailing Address - Phone:860-447-9280
Mailing Address - Fax:860-437-1938
Practice Address - Street 1:48 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-3414
Practice Address - Country:US
Practice Address - Phone:860-447-9280
Practice Address - Fax:860-447-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty