Provider Demographics
NPI:1467110031
Name:TOLLAND DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:TOLLAND DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUEYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-645-1598
Mailing Address - Street 1:118 FAIRWAY XING
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1492
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 GOOSE LN
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3400
Practice Address - Country:US
Practice Address - Phone:860-875-6269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty