Organization
NORTHEAST DENTAL OF CONNECTICUT,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGINIA WICKE (COO)
(732) 610-8265
Entity
Organization
Contact information
Practice address
534 SHELTON AVE, SHELTON, CT 06484-2804
(732) 610-8265
Mailing address
115 W CENTURY RD, SUITE 300, PARAMUS, NJ 07652-1450
(732) 610-8265
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8979
CT
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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