Provider Demographics
NPI:1629106349
Name:CENTER FOR DENTAL EXCELLENCE LLC
Entity Type:Organization
Organization Name:CENTER FOR DENTAL EXCELLENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-658-1991
Mailing Address - Street 1:625 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2449
Mailing Address - Country:US
Mailing Address - Phone:860-658-1991
Mailing Address - Fax:
Practice Address - Street 1:625 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2449
Practice Address - Country:US
Practice Address - Phone:860-658-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056101223G0001X
CT0055101223G0001X
CT0094771223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty