Organization
ELITE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES NGUYEN (OWNER)
(860) 740-5096
Entity
Organization
Contact information
Practice address
1 WILLOWBROOK RD, SUITE 1, CROMWELL, CT 06416-1101
(860) 740-5009
(860) 316-5861
Mailing address
294 PAXTON WAY, GLASTONBURY, CT 06033-3384
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801913660
—
CT
Enumeration date
06/08/2016
Last updated
06/14/2016
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