Organization
PEDIATRIC DENTAL CENTER OF AVON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANMARIE ANN COSGROVE DMD (OWNER)
(860) 674-8417
Entity
Organization
Contact information
Practice address
44 DALE RD STE 305, AVON, CT 06001-4351
(860) 674-8417
(860) 674-8462
Mailing address
44 DALE RD STE 305, AVON, CT 06001-4351
(860) 674-8417
(860) 674-8462
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002088559
—
CT
Enumeration date
07/22/2016
Last updated
07/22/2016
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