Provider Demographics
NPI:1508971557
Name:DENTAL ASSOCIATES OF WETHERSFIELD
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF WETHERSFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RUSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-721-7428
Mailing Address - Street 1:20-30 BEAVER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2242
Mailing Address - Country:US
Mailing Address - Phone:860-721-7428
Mailing Address - Fax:860-257-0757
Practice Address - Street 1:20-30 BEAVER RD STE 102
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2242
Practice Address - Country:US
Practice Address - Phone:860-721-7428
Practice Address - Fax:860-257-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty