Provider Demographics
NPI:1821267667
Name:OXFORD DENTAL GROUP
Entity Type:Organization
Organization Name:OXFORD DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-888-6060
Mailing Address - Street 1:100 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1943
Mailing Address - Country:US
Mailing Address - Phone:203-888-6060
Mailing Address - Fax:
Practice Address - Street 1:100 OXFORD RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1943
Practice Address - Country:US
Practice Address - Phone:203-888-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty