Provider Demographics
NPI:1588625727
Name:PRINDIVILLE, DAVID E (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:PRINDIVILLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 TIMROD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6734
Mailing Address - Country:US
Mailing Address - Phone:860-649-0026
Mailing Address - Fax:
Practice Address - Street 1:945 MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6064
Practice Address - Country:US
Practice Address - Phone:860-647-9926
Practice Address - Fax:860-645-7723
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT48451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT020004845CT01OtherANTHEM BLUE CROSS
CT2V5966OtherHEALTHNET
CTHAS748OtherOXFORD
CT078677OtherCONNECTICARE
CTHAS748OtherOXFORD