Organization
MERIDEN ADULT AND CHILDREN'S PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELBA RIVERA (ADMINISTRATIVE ASST)
(203) 690-9687
Entity
Organization
Contact information
Practice address
415 BROAD ST, MERIDEN, CT 06450-9999
(203) 690-9687
Mailing address
415 BROAD ST, MERIDEN ADULT AND CHILDREN PC, MERIDEN, CT 06450-9999
(203) 690-9687
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1720372840
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720372840
—
CT
Enumeration date
04/30/2014
Last updated
04/30/2014
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