Provider Demographics
NPI:1790080265
Name:DAVID SCHWABER D.D.S.
Entity Type:Organization
Organization Name:DAVID SCHWABER D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWABER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-673-9141
Mailing Address - Street 1:PO BOX 2003
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-1003
Mailing Address - Country:US
Mailing Address - Phone:860-673-9141
Mailing Address - Fax:860-673-4842
Practice Address - Street 1:9 COVEY RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06013-1720
Practice Address - Country:US
Practice Address - Phone:860-673-9141
Practice Address - Fax:860-673-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6477840001Medicare NSC