Provider Demographics
NPI:1790398428
Name:CT OROFACIAL MYOLOGY, LLC
Entity Type:Organization
Organization Name:CT OROFACIAL MYOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCIARRA
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:203-217-7090
Mailing Address - Street 1:384 MIXVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1968
Mailing Address - Country:US
Mailing Address - Phone:203-217-7090
Mailing Address - Fax:
Practice Address - Street 1:384 MIXVILLE RD
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1968
Practice Address - Country:US
Practice Address - Phone:203-217-7090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty