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Organization
GRANBY DENTAL, LLC
Active
Organization
GRANBY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD S. KIRSCHBAUM DDS (OWNER)
(860) 653-7596
Entity
Organization
Contact information
Practice address
26 EAST GRANBY RD., GRANBY, CT 06035-0450
(860) 653-7596
(860) 653-9536
Mailing address
26 EAST GRANBY RD., P.O. BOX 450, GRANBY, CT 06035-0450
(860) 653-7596
(860) 653-9536
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
Other
Enumeration date
01/23/2007
Last updated
04/01/2013
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