Organization
NEW LONDON DENTAL CARE, LLC
Active
Other names
New London Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE DEVRIES (BUSINESS MANAGER)
(860) 342-4141
Entity
Organization
Contact information
Practice address
258 S FRONTAGE RD, NEW LONDON, CT 06320-2641
(860) 437-3462
(860) 437-3485
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
9920
CT
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
06/24/2011
Last updated
06/06/2014
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