Provider Demographics
NPI:1184960825
Name:AMBULATORY DENTAL ANESTHESIA ASSOCIATES, LLC
Entity type:Organization
Organization Name:AMBULATORY DENTAL ANESTHESIA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOKOLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-804-8875
Mailing Address - Street 1:607 ASPEN LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2161
Mailing Address - Country:US
Mailing Address - Phone:203-804-8875
Mailing Address - Fax:203-306-3019
Practice Address - Street 1:607 ASPEN LN
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-2161
Practice Address - Country:US
Practice Address - Phone:203-804-8875
Practice Address - Fax:203-306-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty