Organization
WOLCOTT STREET DENTAL-2, PC
Active
Other names
Sutton Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JACOMINO (DIRECTOR OF PAYOR RELATIONS)
(770) 916-5036
Entity
Organization
Contact information
Practice address
1888 MAIN ST, HARTFORD, CT 06120-2357
(800) 920-9947
Mailing address
210 INTERSTATE NORTH PKWY SE STE 300, ATLANTA, GA 30339-2233
(770) 916-5028
(678) 247-7858
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
03/29/2010
Last updated
08/19/2022
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