Organization
PEDIATRIC DENTAL ASSOCIATES OF SOUTHBURY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARGUERITE C GILLETTE (OFFICE MANAGER)
(203) 264-1497
Entity
Organization
Contact information
Practice address
1 POMPERAUG OFFICE PARK, SUITE 206, SOUTHBURY, CT 06488-2295
(203) 264-1497
(203) 264-4039
Mailing address
1 POMPERAUG OFFICE PARK, SUITE 206, SOUTHBURY, CT 06488-2295
(203) 264-1497
(203) 264-4039
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
007834
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008001055
—
CT
Enumeration date
08/19/2008
Last updated
08/19/2008
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