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1402 Berlin Tpke Wethersfield CT 06109-1010 | |
| (860) 956-1396 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1402 Berlin Tpke, Wethersfield, Connecticut |
| Authorized Official Name and Position | James Nguyen (OWNER DENTIST) |
| Authorized Official Contact | 8609561396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1402 Berlin Turnpike Wethersfield CT 06109 Ph: (860) 956-1396 | 1402 Berlin Tpke Wethersfield CT 06109-1010 Ph: (860) 956-1396 |
| NPI Number | 1255561346 |
|---|---|
| Provider Enumeration Date | 07/23/2009 |
| Last Update Date | 02/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255561346 | NPI | - | NPPES |
| 9130 | Other | CT | STATE LICENSE |
| 002091304 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 9130 (Connecticut) | Primary |
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