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Organization

SPH2 ENTERPRISE, LLC

Active
Other names
Care Dental Center
Organization subpart
No

Provider details

NPI number
Authorized official
MS. DIANE DEVRIES (BUSINESS MANAGER)
(860) 342-4141
Entity
Organization

Contact information

Practice address
191 FRANKLIN AVE, HARTFORD, CT 06114
(860) 296-7460
(860) 296-7459
Mailing address
191 FRANKLIN AVE, HARTFORD, CT 06114
(860) 296-7460
(860) 296-7459

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9846
CT
1223G0001X
General Practice Dentistry
CT009785
CT
1223G0001X
General Practice Dentistry
CT009846
CT
1223G0001X
General Practice Dentistry
CT009920
CT
1223P0106X
Oral and Maxillofacial Pathology Dentistry
CT
1223P0221X
Pediatric Dentistry
CT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
008002144
CT
05
008002145
CT
05
008002146
CT
Enumeration date
12/11/2009
Last updated
06/17/2014
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