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PROFESSIONAL DENTAL ALLIANCE OF OLD SAYBROOK PLLC NPI 1235620774


NPI Information

NPI: 1235620774
Provider Name: PROFESSIONAL DENTAL ALLIANCE OF OLD SAYBROOK, PLLC

Doing Business As: LIFE LONG DENTAL CARE OF OLD SAYBROOK

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
711 BOSTON POST RD
OLD SAYBROOK, CT
ZIP 06475
Phone: (860) 388-0242
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PROFESSIONAL DENTAL ALLIANCE OF OLD SAYBROOK, PLLC is a general practice dentist in Old Saybrook, 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. PROFESSIONAL DENTAL ALLIANCE OF OLD SAYBROOK, PLLC NPI is 1235620774. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Life Long Dental Care Of Old Saybrook.

The provider's business location address is:

711 BOSTON POST RD
OLD SAYBROOK, CT
ZIP 06475-125
Phone: (860) 388-0242

The provider's authorized official is Andrew Matta .
The authorized official title is Cmo/owner and has the following contact phone number (724) 698-2500.

The enumeration date for this NPI number is 5/21/2018 and was last updated on 5/21/2018.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral PracticeYes

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: 5/5/2024

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