Organization
CHARTER OAK DENTAL CENTER LL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELINA BLANKSCHEN (ADMINISTRATOR)
(860) 997-0569
Entity
Organization
Contact information
Practice address
165 EAST MAIN STREET, NEW BRITAIN, CT 06051
(860) 224-0797
(860) 224-0799
Mailing address
165 EAST MAIN STREET, NEW BRITAIN, CT 06051
(860) 224-0797
(860) 224-0799
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11063
CONNECTICUT DENTAL LICENSE
CT
Enumeration date
01/11/2019
Last updated
01/11/2019
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