Provider Demographics
NPI:1821421827
Name:B & R DENTAL, LLC
Entity Type:Organization
Organization Name:B & R DENTAL, LLC
Other - Org Name:WEST MAIN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRADEEPA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOVVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-302-2828
Mailing Address - Street 1:105 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2216
Mailing Address - Country:US
Mailing Address - Phone:860-229-0750
Mailing Address - Fax:
Practice Address - Street 1:105 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2216
Practice Address - Country:US
Practice Address - Phone:860-229-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0107901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty