Provider Demographics
NPI:1841408648
Name:ARTISTIC DENTAL MEDICINE
Entity Type:Organization
Organization Name:ARTISTIC DENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FERNANDEZ-BAUJIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-379-3830
Mailing Address - Street 1:2492 TORRINGFORD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-2523
Mailing Address - Country:US
Mailing Address - Phone:860-234-7970
Mailing Address - Fax:
Practice Address - Street 1:512 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06057
Practice Address - Country:US
Practice Address - Phone:860-379-3830
Practice Address - Fax:860-379-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty