Provider Demographics
NPI:1205545704
Name:GLASTONBURY DENTAL CARE
Entity type:Organization
Organization Name:GLASTONBURY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADITYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHYAP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-417-5324
Mailing Address - Street 1:15 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-4005
Mailing Address - Country:US
Mailing Address - Phone:713-417-5324
Mailing Address - Fax:
Practice Address - Street 1:1420 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3110
Practice Address - Country:US
Practice Address - Phone:860-659-0278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty