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Organization
SPH2 ENTERPRISE, LLC
Active
Organization
SPH2 ENTERPRISE, LLC
Active
Other names
Care Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE DEVRIES (BUSINESS MANAGER)
(860) 342-4141
Entity
Organization
Contact information
Practice address
191 FRANKLIN AVE, HARTFORD, CT 06114
(860) 296-7460
(860) 296-7459
Mailing address
191 FRANKLIN AVE, HARTFORD, CT 06114
(860) 296-7460
(860) 296-7459
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9846
CT
1223G0001X
General Practice Dentistry
CT009785
CT
1223G0001X
General Practice Dentistry
CT009846
CT
1223G0001X
General Practice Dentistry
CT009920
CT
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
CT
1223P0221X
Pediatric Dentistry
—
CT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008002144
—
CT
05
—
008002145
—
CT
05
—
008002146
—
CT
Enumeration date
12/11/2009
Last updated
06/17/2014
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