Organization
PEDIATRIC DENTISTRY AND ORTHODONTICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AIMEE HODGERNEY (OPERATIONS MANAGER)
(508) 589-8270
Entity
Organization
Contact information
Practice address
1 LAKE ST, NEW BRITAIN, CT 06052-1396
(508) 589-8270
Mailing address
87 ELM ST STE 302, HOPKINTON, MA 01748-1638
(508) 589-8270
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
011318
CT
Other
Enumeration date
01/22/2018
Last updated
05/24/2019
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