Provider Demographics
NPI:1841426962
Name:LITCHFIELD HILLS FAMILY DENTAL
Entity Type:Organization
Organization Name:LITCHFIELD HILLS FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-496-0256
Mailing Address - Street 1:241 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3013
Mailing Address - Country:US
Mailing Address - Phone:860-496-0256
Mailing Address - Fax:860-496-0863
Practice Address - Street 1:241 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3013
Practice Address - Country:US
Practice Address - Phone:860-496-0256
Practice Address - Fax:860-496-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty