Provider Demographics
NPI:1831323435
Name:SALMONBROOK DENTAL ASSOCIATES, L.L.C.
Entity Type:Organization
Organization Name:SALMONBROOK DENTAL ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDRES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-653-4551
Mailing Address - Street 1:33 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2309
Mailing Address - Country:US
Mailing Address - Phone:860-653-4551
Mailing Address - Fax:
Practice Address - Street 1:33 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-2309
Practice Address - Country:US
Practice Address - Phone:860-653-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6542261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental