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Organization
LAFAYETTE DENTAL GROUP, PC
Active
Organization
LAFAYETTE DENTAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID S RICHARDSON DDS (PRESIDENT)
(860) 889-5213
Entity
Organization
Contact information
Practice address
67 LAFAYETTE ST, NORWICH, CT 06360-3407
(860) 889-5213
(860) 886-0100
Mailing address
200 WOODLAND ST, SOUTH GLASTONBURY, CT 06073-2717
(860) 659-3450
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7568
CT
1223G0001X
General Practice Dentistry
9345
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020007568CT03
ANTHEM BCBS CT
CT
01
—
020009345CT02
ANTHEM BCBS CT
CT
01
—
1548343858
NPI NUMBER ISSUED
—
01
—
1651844
UNITED CONCORDIA
—
01
—
1904629
UNITED CONCORDIA
—
01
—
815896
UNITED CONCORDIA
—
Enumeration date
01/30/2007
Last updated
08/22/2020
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