Organization
AVON VILLAGE FAMILY DENTISTRY
Active
Other names
Avon Village Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAUREN M MENTASTI DMD (OWNER)
(860) 678-1140
Entity
Organization
Contact information
Practice address
32 EAST MAIN STREET, AVON, CT 06001-1039
(860) 678-1140
(860) 284-4423
Mailing address
32 EAST MAIN STREET, AVON, CT 06001-1039
(860) 678-1140
(860) 284-4423
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7587810001
—
CT
Enumeration date
03/30/2007
Last updated
02/05/2024
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