Provider Demographics
NPI:1972047116
Name:NEWTOWN FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:NEWTOWN FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-426-0045
Mailing Address - Street 1:172 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1443
Mailing Address - Country:US
Mailing Address - Phone:203-426-0045
Mailing Address - Fax:
Practice Address - Street 1:172 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1443
Practice Address - Country:US
Practice Address - Phone:203-426-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0115811223G0001X
CT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty