Provider Demographics
NPI:1336849413
Name:FARMINGTON FAMILY DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:FARMINGTON FAMILY DENTAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-677-1316
Mailing Address - Street 1:5 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2251
Mailing Address - Country:US
Mailing Address - Phone:860-677-1316
Mailing Address - Fax:
Practice Address - Street 1:5 MELROSE DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2251
Practice Address - Country:US
Practice Address - Phone:860-677-1316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental