Provider Demographics
NPI:1518556877
Name:KILLINGLY DENTAL CARE, LLC
Entity Type:Organization
Organization Name:KILLINGLY DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-779-1053
Mailing Address - Street 1:1040 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-2143
Mailing Address - Country:US
Mailing Address - Phone:860-779-1053
Mailing Address - Fax:860-779-7137
Practice Address - Street 1:1040 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-2143
Practice Address - Country:US
Practice Address - Phone:860-779-1053
Practice Address - Fax:860-779-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1962656397OtherGENERAL DENTISTRY