Provider Demographics
NPI:1689823171
Name:DENTAL ARTS OF AVON, P.C
Entity Type:Organization
Organization Name:DENTAL ARTS OF AVON, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-284-4411
Mailing Address - Street 1:9 AVONWOOD RD
Mailing Address - Street 2:BUILDING #B
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2072
Mailing Address - Country:US
Mailing Address - Phone:860-284-4411
Mailing Address - Fax:860-679-9389
Practice Address - Street 1:9 AVONWOOD RD
Practice Address - Street 2:BUILDING #B
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2072
Practice Address - Country:US
Practice Address - Phone:860-284-4411
Practice Address - Fax:860-679-9389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT94361223G0001X
CT96821223G0001X
CT7403124Q00000X
126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty