Organization
CT DENTAL LLC
Active
Other names
Connecticut Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TULASI N VIKRAM DDS (OWNER)
(203) 574-2725
Entity
Organization
Contact information
Practice address
171 GRANDVIEW AVE, SUITE 103, WATERBURY, CT 06708-2517
(203) 574-2725
(203) 574-2726
Mailing address
171 GRANDVIEW AVE, SUITE 103, WATERBURY, CT 06708-2517
(203) 574-2725
(203) 574-2726
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
010282
CT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
CT
Other
Enumeration date
05/23/2011
Last updated
01/07/2015
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