Provider Demographics
NPI:1508069451
Name:FAIRFIELD PERIODONTICS, LLC
Entity Type:Organization
Organization Name:FAIRFIELD PERIODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SHAPOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-255-7771
Mailing Address - Street 1:71 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6001
Mailing Address - Country:US
Mailing Address - Phone:203-255-7771
Mailing Address - Fax:203-255-5753
Practice Address - Street 1:71 BEACH RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6001
Practice Address - Country:US
Practice Address - Phone:203-255-7771
Practice Address - Fax:203-255-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty