Provider Demographics
NPI:1942531157
Name:ZOTTOLA PERIODONTAL GROUP, LLC
Entity Type:Organization
Organization Name:ZOTTOLA PERIODONTAL GROUP, LLC
Other - Org Name:ZOTTOLA FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL-HENRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZOTTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:860-436-9571
Mailing Address - Street 1:2275 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2329
Mailing Address - Country:US
Mailing Address - Phone:860-436-9571
Mailing Address - Fax:860-436-9573
Practice Address - Street 1:2275 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2329
Practice Address - Country:US
Practice Address - Phone:860-436-9571
Practice Address - Fax:860-436-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0089661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty