Provider Demographics
NPI:1518401702
Name:FAIRFIELD COUNTY IMPLANTS AND PERIODONTICS
Entity Type:Organization
Organization Name:FAIRFIELD COUNTY IMPLANTS AND PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:SONICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-254-2006
Mailing Address - Street 1:1047 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5906
Mailing Address - Country:US
Mailing Address - Phone:203-254-2006
Mailing Address - Fax:203-254-9201
Practice Address - Street 1:1047 OLD POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5906
Practice Address - Country:US
Practice Address - Phone:203-254-2006
Practice Address - Fax:203-254-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT64341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty