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BLUE BACK DENTAL LLC NPI 1174814495


NPI Information

NPI: 1174814495
Provider Name: BLUE BACK DENTAL LLC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
65 MEMORIAL RD STE 400
WEST HARTFORD, CT
ZIP 06107
Phone: (860) 233-9300
Get Directions

BLUE BACK DENTAL LLC is a general practice dentist in West Hartford, CT. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. BLUE BACK DENTAL LLC NPI is 1174814495. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

65 MEMORIAL RD STE 400
WEST HARTFORD, CT
ZIP 06107-219
Phone: (860) 233-9300
Fax: (860) 233-9304

The provider's authorized official is Kirsten E Capozzi .
The authorized official title is Practice Manager and has the following contact phone number (860) 233-9300.

The enumeration date for this NPI number is 4/20/2011 and was last updated on 4/20/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral Practice8915CONNECTICUTNo
21223P0300XDentistPeriodontics5407CONNECTICUTNo
31223G0001XDentistGeneral Practice5904CONNECTICUTYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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