Provider Demographics
NPI:1598496218
Name:WELLNESS DENTAL CARE LLC
Entity Type:Organization
Organization Name:WELLNESS DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FORUM
Authorized Official - Middle Name:DIPAK
Authorized Official - Last Name:JOBANPUTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:551-689-5859
Mailing Address - Street 1:29D ROBBINS LN FL 2
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1405
Mailing Address - Country:US
Mailing Address - Phone:551-689-5859
Mailing Address - Fax:
Practice Address - Street 1:465 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2134
Practice Address - Country:US
Practice Address - Phone:551-689-5859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty