Provider Demographics
NPI:1972721876
Name:PEDIATRIC DENTISTRY OF LITCHFIELD COUNTY, LLC
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF LITCHFIELD COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:YING
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-482-9578
Mailing Address - Street 1:148 MIGEON AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-4817
Mailing Address - Country:US
Mailing Address - Phone:860-482-9578
Mailing Address - Fax:
Practice Address - Street 1:148 MIGEON AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-4817
Practice Address - Country:US
Practice Address - Phone:860-482-9578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0094021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty