Provider Demographics
NPI:1558327684
Name:ADVANCED ENDODONTICS OF CT PC
Entity Type:Organization
Organization Name:ADVANCED ENDODONTICS OF CT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHASEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-237-7449
Mailing Address - Street 1:546 S BROAD STREET
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450
Mailing Address - Country:US
Mailing Address - Phone:203-237-7449
Mailing Address - Fax:203-237-1234
Practice Address - Street 1:546 S BROAD ST SUITE 3B
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06650
Practice Address - Country:US
Practice Address - Phone:203-237-7449
Practice Address - Fax:203-237-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46891223E0200X
CT78841223E0200X
CT90311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty