| Pediatric Dental Center Of Avon, Llc | |
|
44 Dale Rd Ste 305 Avon CT 06001-4351 | |
| (860) 674-8417 | |
| (860) 674-8462 |
| Full Name | Pediatric Dental Center Of Avon, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 44 Dale Rd Ste 305, Avon, Connecticut |
| Authorized Official Name and Position | Jeanmarie Ann Cosgrove (OWNER) |
| Authorized Official Contact | 8606748417 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental Center Of Avon, Llc 44 Dale Rd Ste 305 Avon CT 06001-4351 Ph: (860) 674-8417 | Pediatric Dental Center Of Avon, Llc 44 Dale Rd Ste 305 Avon CT 06001-4351 Ph: (860) 674-8417 |
| NPI Number | 1033562210 |
|---|---|
| Provider Enumeration Date | 07/22/2016 |
| Last Update Date | 07/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033562210 | NPI | - | NPPES |
| 002088559 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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