Provider Demographics
NPI:1982179990
Name:NEWINGTON DENTISTRY AND BRACES INC
Entity Type:Organization
Organization Name:NEWINGTON DENTISTRY AND BRACES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-580-1524
Mailing Address - Street 1:5 MOUNT ROYAL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1900
Mailing Address - Country:US
Mailing Address - Phone:508-460-0632
Mailing Address - Fax:
Practice Address - Street 1:2985 BERLIN TPKE UNIT 7A
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4601
Practice Address - Country:US
Practice Address - Phone:860-748-4888
Practice Address - Fax:860-748-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty