| Full Name | |
|---|---|
| Speciality | Durable Medical Equipment & Medical Supplies |
| Location | 15 Amadeo Dr, Bethany, Connecticut |
| Authorized Official Name and Position | Zachary Korwin (OWNER) |
| Authorized Official Contact | 8484592584 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
15 Amadeo Dr Bethany CT 06524-3186 Ph: (848) 459-2584 | 15 Amadeo Dr Bethany CT 06524-3186 Ph: (848) 459-2584 |
| NPI Number | 1588418677 |
|---|---|
| Provider Enumeration Date | 04/15/2024 |
| Last Update Date | 01/06/2025 |
| Medicare PECOS PAC ID | 2860934106 |
|---|---|
| Medicare Enrollment ID | O20240603001247 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588418677 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Primary |
| Provider Name | Zachary F Korwin |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1669886123 PECOS PAC ID: 5294049250 Enrollment ID: I20240624003737 |
Amity Dental Care Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 696 Amity Rd Ste A3, Bethany, CT 06524 Phone: 203-393-1660 Fax: 203-393-1922 | |
Mobile Dental Care Associate Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 55 Sargent Drive, Bethany, CT 06524 Phone: 475-238-8165 Fax: 475-655-2967 |