Provider Demographics
NPI:1689722365
Name:COASTAL CONNECTICUT DENTISTRY, LLC
Entity Type:Organization
Organization Name:COASTAL CONNECTICUT DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-447-1787
Mailing Address - Street 1:112 CROSS ROAD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-447-1787
Mailing Address - Fax:860-447-1211
Practice Address - Street 1:112 CROSS ROAD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-447-1787
Practice Address - Fax:860-447-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT90961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty