Provider Demographics
NPI:1558745539
Name:NEW AGE DENTAL LLC
Entity Type:Organization
Organization Name:NEW AGE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELZBIETA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BASIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-561-2121
Mailing Address - Street 1:10 N MAIN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1968
Mailing Address - Country:US
Mailing Address - Phone:860-561-2121
Mailing Address - Fax:860-561-4327
Practice Address - Street 1:10 N MAIN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1968
Practice Address - Country:US
Practice Address - Phone:860-561-2121
Practice Address - Fax:860-561-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-19
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0085101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty