Provider Demographics
NPI:1134663578
Name:EAST CEDAR DENTAL, INC.
Entity type:Organization
Organization Name:EAST CEDAR DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:FARROKH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-667-0875
Mailing Address - Street 1:59 E CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2533
Mailing Address - Country:US
Mailing Address - Phone:860-667-0875
Mailing Address - Fax:
Practice Address - Street 1:59 E CEDAR ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2533
Practice Address - Country:US
Practice Address - Phone:860-667-0875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty