Provider Demographics
NPI:1922029768
Name:UNIVERSITY DENTISTS
Entity Type:Organization
Organization Name:UNIVERSITY DENTISTS
Other - Org Name:UNIVERSITY DENTISTS-SCHOOL OF DENTAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DEAN FOR CLINICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEPOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-679-4885
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:ATTN: ELLIE ATKINS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-0001
Mailing Address - Country:US
Mailing Address - Phone:860-679-2207
Mailing Address - Fax:860-679-1899
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:MC2105
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-2464
Practice Address - Fax:860-679-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0330261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004010807Medicaid
CT004010807Medicaid