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1 Boulder Ave Old Greenwich CT 06870-1420 | |
| (203) 990-3300 | |
| (212) 202-6447 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1 Boulder Ave, Old Greenwich, Connecticut |
| Authorized Official Name and Position | Janet C Bodey (MANAGING MEMBER) |
| Authorized Official Contact | 2039987470 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6118 Riverdale Ave Bronx NY 10471-1009 Ph: (203) 998-7470 | 1 Boulder Ave Old Greenwich CT 06870-1420 Ph: (203) 990-3300 |
| NPI Number | 1861920068 |
|---|---|
| Provider Enumeration Date | 06/01/2017 |
| Last Update Date | 06/01/2017 |
| Medicare PECOS PAC ID | 2163780099 |
|---|---|
| Medicare Enrollment ID | O20171221001827 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861920068 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 9973 (Connecticut) | Primary |
| Provider Name | Janet C Bodey |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1568504538 PECOS PAC ID: 8123119179 Enrollment ID: I20171221001964 |
Old Greenwhich Dental Center Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 182 Sound Beach Ave, Old Greenwich, CT 06870 Phone: 917-915-4504 |