Provider Demographics
NPI:1578943528
Name:ROBERTA J GARCEAU DMD LLC
Entity Type:Organization
Organization Name:ROBERTA J GARCEAU DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARCEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-688-4325
Mailing Address - Street 1:62 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2808
Mailing Address - Country:US
Mailing Address - Phone:860-688-4325
Mailing Address - Fax:860-285-8766
Practice Address - Street 1:62 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2808
Practice Address - Country:US
Practice Address - Phone:860-688-4325
Practice Address - Fax:860-285-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty