Provider Demographics
NPI:1588616247
Name:HUNTINGTON FAMILY DENTAL GROUP
Entity Type:Organization
Organization Name:HUNTINGTON FAMILY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-929-6338
Mailing Address - Street 1:534 SHELTON AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2804
Mailing Address - Country:US
Mailing Address - Phone:203-929-6338
Mailing Address - Fax:203-929-7619
Practice Address - Street 1:534 SHELTON AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-2804
Practice Address - Country:US
Practice Address - Phone:203-929-6338
Practice Address - Fax:203-929-7619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT47491223G0001X
CT48011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty