Organization
SPH3ENTERPRISE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE LAVOIE (OFFICE MANAGER)
(860) 644-0099
Entity
Organization
Contact information
Practice address
194 BUCKLAND HILLS DRIVE, MANCHESTER, CT 06042
(860) 644-0099
(860) 644-0109
Mailing address
194 BUCKLAND HILLS DR, MANCHESTER, CT 06042-8705
(860) 644-0099
(860) 644-0109
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
010954
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467611632
—
CT
05
—
1972893352
—
CT
Enumeration date
07/07/2014
Last updated
07/07/2014
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