Provider Demographics
NPI:1609814730
Name:ROCKY HILL DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ROCKY HILL DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-563-6500
Mailing Address - Street 1:55 TOWN LINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4352
Mailing Address - Country:US
Mailing Address - Phone:860-563-6500
Mailing Address - Fax:860-563-6501
Practice Address - Street 1:55 TOWN LINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4352
Practice Address - Country:US
Practice Address - Phone:860-563-6500
Practice Address - Fax:860-563-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT50401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty