| Organization Name: | OLD LYME DENTAL ASSOCIATES LLC |
| NPI Number: | 1942443726 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY B LAMURA (DENTIST/OWNER) |
| Mailing Address: | 19 Halls Rd Suite 218 Old Lyme |
| State: | CT US |
| Postal Code: | 063711457 |
| Phone Number: | 8604347378 |
| Fax Number: | 8604347537 |
| NPI Enumeration Date: | 04/09/2009 |
| NPI Last Update Date: | 04/09/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 9618 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |