Provider Demographics
NPI:1922378256
Name:HARTFORD DENTAL CARE , LLC
Entity Type:Organization
Organization Name:HARTFORD DENTAL CARE , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-635-6888
Mailing Address - Street 1:26 SHUNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2442
Mailing Address - Country:US
Mailing Address - Phone:860-635-6888
Mailing Address - Fax:
Practice Address - Street 1:18 MADISON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2324
Practice Address - Country:US
Practice Address - Phone:860-635-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0100411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty