Organization
TODDLESR TO TEENS PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OSCAR GONZALEZ D.D.S. (OWNER/ DIRECTOR)
(860) 521-2500
Entity
Organization
Contact information
Practice address
1340 BOULEVARD, WEST HARTFORD, CT 06119-1901
(860) 521-2500
(860) 521-2501
Mailing address
1340 BOULEVARD, WEST HARTFORD, CT 06119-1901
(860) 521-2500
(860) 521-2501
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
7093
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002070936
—
CT
Enumeration date
01/09/2012
Last updated
01/17/2012
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