Provider Demographics
NPI:1477802841
Name:A.G.N. DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:A.G.N. DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:NATH-VINICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-668-7303
Mailing Address - Street 1:133 MOUNTAIN RD.
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078
Mailing Address - Country:US
Mailing Address - Phone:860-668-7303
Mailing Address - Fax:860-668-5079
Practice Address - Street 1:133 MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078
Practice Address - Country:US
Practice Address - Phone:860-668-7303
Practice Address - Fax:860-668-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty