Provider Demographics
NPI:1467555995
Name:FARMINGTON VALLEY ORTHODONTIC ASSOCIATES
Entity Type:Organization
Organization Name:FARMINGTON VALLEY ORTHODONTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEPASQUALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-673-6105
Mailing Address - Street 1:20 WEST AVON ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-673-6105
Mailing Address - Fax:860-673-6111
Practice Address - Street 1:20 WEST AVON ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-673-6105
Practice Address - Fax:860-673-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT62131223X0400X
CT44101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty