Provider Demographics
NPI:1639892680
Name:CONNECTICUT TONGUE TIE CENTER LLC
Entity Type:Organization
Organization Name:CONNECTICUT TONGUE TIE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-529-1242
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-0112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 OLD RIDGEFIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3047
Practice Address - Country:US
Practice Address - Phone:203-529-1242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental