Provider Demographics
NPI:1689756710
Name:DENTAL ASSOCIATES OF ROCKVILLE LLC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF ROCKVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:JANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-872-0794
Mailing Address - Street 1:50 HALE ST
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3840
Mailing Address - Country:US
Mailing Address - Phone:860-872-0794
Mailing Address - Fax:860-871-7504
Practice Address - Street 1:50 HALE ST
Practice Address - Street 2:
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-3840
Practice Address - Country:US
Practice Address - Phone:860-872-0794
Practice Address - Fax:860-871-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty