Organization
SPH2 ENTERPRISE LLC
Active
Other names
Meriden Family Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE DEVRIES (BUSINESS MANAGER)
(860) 342-4141
Entity
Organization
Contact information
Practice address
470 LEWIS AVE, MERIDEN, CT 06451-2103
(860) 342-4141
(860) 342-1284
Mailing address
553 PORTLAND COBALT RD, PORTLAND, CT 06480-1968
(860) 342-4141
(860) 342-1284
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
009785
CT
1223G0001X
General Practice Dentistry
009846
CT
1223G0001X
General Practice Dentistry
009920
CT
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
04/07/2010
Last updated
06/18/2014
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