Provider Demographics
NPI:1467674820
Name:MANSFIELD CT DENTAL PLLC
Entity Type:Organization
Organization Name:MANSFIELD CT DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:LAURIE
Authorized Official - Last Name:CZARNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:860-456-2906
Mailing Address - Street 1:10 HIGGINS HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1437
Mailing Address - Country:US
Mailing Address - Phone:860-456-2906
Mailing Address - Fax:
Practice Address - Street 1:10 HIGGINS HWY STE 1
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:860-456-2906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6334122300000X
CT6192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty