Organization
CHILDREN'S DENTAL ASSOCIATES OF NLC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE S HERTER (MANGER)
(860) 886-5576
Entity
Organization
Contact information
Practice address
392 SALEM TPKE, BOZRAH, CT 06334-1519
(860) 886-5576
(860) 885-1379
Mailing address
392 SALEM TPKE, BOZRAH, CT 06334-1519
(860) 886-5576
(860) 885-1379
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004119211
—
CT
Enumeration date
10/26/2005
Last updated
01/11/2011
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