| Sph3enterprise, Llc | |
|
194 Buckland Hills Drive Manchester CT 06042 | |
| (860) 644-0099 | |
| (860) 644-0109 |
| Full Name | Sph3enterprise, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 194 Buckland Hills Drive, Manchester, Connecticut |
| Authorized Official Name and Position | Andre Lavoie (OFFICE MANAGER) |
| Authorized Official Contact | 8606440099 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sph3enterprise, Llc 194 Buckland Hills Dr Manchester CT 06042-8705 Ph: (860) 644-0099 | Sph3enterprise, Llc 194 Buckland Hills Drive Manchester CT 06042 Ph: (860) 644-0099 |
| NPI Number | 1053727479 |
|---|---|
| Provider Enumeration Date | 07/07/2014 |
| Last Update Date | 07/07/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053727479 | NPI | - | NPPES |
| 1467611632 | Medicaid | CT | |
| 1972893352 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 010954 (Connecticut) | Primary |
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