Provider Demographics
NPI:1811387863
Name:RYAZ ANSARI LLC
Entity Type:Organization
Organization Name:RYAZ ANSARI LLC
Other - Org Name:WEST HARTFORD IMPLANT DENITISTRY, ORAL AND FACIAL SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-232-4606
Mailing Address - Street 1:928 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2227
Mailing Address - Country:US
Mailing Address - Phone:860-232-4606
Mailing Address - Fax:860-233-8359
Practice Address - Street 1:483 MIDDLE TPKE W
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3863
Practice Address - Country:US
Practice Address - Phone:860-649-2272
Practice Address - Fax:860-533-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009050261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental