Provider Demographics
NPI:1598328874
Name:WEST HARTFORD DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:WEST HARTFORD DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:UKTI
Authorized Official - Middle Name:GOHEL
Authorized Official - Last Name:PHADNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-300-3288
Mailing Address - Street 1:12 N MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1932
Mailing Address - Country:US
Mailing Address - Phone:860-236-4249
Mailing Address - Fax:860-231-1571
Practice Address - Street 1:12 N MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1932
Practice Address - Country:US
Practice Address - Phone:860-236-4249
Practice Address - Fax:860-231-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty