Organization Name: | HOUSATONIC VALLEY DENTAL CARE |
NPI Number: | 1023423399 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN DANNON (PRESIDENT) |
Mailing Address: | 60 Church Street Canaan |
State: | CT US |
Postal Code: | 06018 |
Phone Number: | 8605592664 |
Fax Number: | |
NPI Enumeration Date: | 06/25/2014 |
NPI Last Update Date: | 06/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 10357 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |