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Organization
MODERN FAMILY DENTAL
Active
Organization
MODERN FAMILY DENTAL
Active
Other names
SGroup LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA MROWKA (OFFICE MANAGER)
(860) 437-3462
Entity
Organization
Contact information
Practice address
360 BOSTON AVE, SUITE 17, STRATFORD, CT 06614-5213
(860) 437-3462
(860) 437-3485
Mailing address
320 BOSTON AVE, SUITE 17, STRATFORD, CT 06614-5213
(860) 437-3462
(860) 437-3485
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
CT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386035707
—
CT
05
—
1942579768
—
CT
Enumeration date
02/06/2015
Last updated
09/21/2015
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