| Pediatric Dental Associates Of Southbury Llc | |
|
1 Pomperaug Office Park Suite 206 Southbury CT 06488-2295 | |
| (203) 264-1497 | |
| (203) 264-4039 |
| Full Name | Pediatric Dental Associates Of Southbury Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1 Pomperaug Office Park, Southbury, Connecticut |
| Authorized Official Name and Position | Marguerite C Gillette (OFFICE MANAGER) |
| Authorized Official Contact | 2032641497 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental Associates Of Southbury Llc 1 Pomperaug Office Park Suite 206 Southbury CT 06488-2295 Ph: (203) 264-1497 | Pediatric Dental Associates Of Southbury Llc 1 Pomperaug Office Park Suite 206 Southbury CT 06488-2295 Ph: (203) 264-1497 |
| NPI Number | 1629225875 |
|---|---|
| Provider Enumeration Date | 08/19/2008 |
| Last Update Date | 08/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629225875 | NPI | - | NPPES |
| 008001055 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 007834 (Connecticut) | Primary |
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