Provider Demographics
NPI:1639508740
Name:MARKOWSKI DENTAL ASSOCIATES P C
Entity type:Organization
Organization Name:MARKOWSKI DENTAL ASSOCIATES P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROFIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-668-0241
Mailing Address - Street 1:162 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2091
Mailing Address - Country:US
Mailing Address - Phone:860-668-0241
Mailing Address - Fax:860-668-8788
Practice Address - Street 1:162 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2091
Practice Address - Country:US
Practice Address - Phone:860-668-0241
Practice Address - Fax:860-668-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0103061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008001796Medicaid
CT008020155Medicaid
CT008040008Medicaid
CT008001796Medicaid