Provider Demographics
NPI:1588005243
Name:TOOTH & GUMS DENTISTRY
Entity Type:Organization
Organization Name:TOOTH & GUMS DENTISTRY
Other - Org Name:TOOTH & GUMZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVIRAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-293-2003
Mailing Address - Street 1:1500 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-2113
Mailing Address - Country:US
Mailing Address - Phone:860-293-2003
Mailing Address - Fax:860-293-2007
Practice Address - Street 1:1500 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2113
Practice Address - Country:US
Practice Address - Phone:860-293-2003
Practice Address - Fax:860-293-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0105541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty