Organization
TERRYVILLE FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOSHA SHAH DDS (OWNER)
(860) 583-3582
Entity
Organization
Contact information
Practice address
14 MAPLE ST, TERRYVILLE, CT 06786-5220
(860) 853-3582
(860) 582-8654
Mailing address
14 MAPLE ST, TERRYVILLE, CT 06786-5220
(860) 853-3582
(860) 582-8654
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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