Provider Demographics
NPI:1851329510
Name:PEDIATRIC DENTAL ASSOC P.C.
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL ASSOC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-649-4655
Mailing Address - Street 1:192 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3581
Mailing Address - Country:US
Mailing Address - Phone:860-649-4655
Mailing Address - Fax:860-646-3281
Practice Address - Street 1:192 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3581
Practice Address - Country:US
Practice Address - Phone:860-649-4655
Practice Address - Fax:860-646-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty