ADVANCED DENTAL OF CROMWELL LLC (NPI# 1265942676) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265942676 |
| Entity Type | Organization |
| Organization Name | ADVANCED DENTAL OF CROMWELL LLC |
| Practice Address |
26 Shunpike Rd Ste A Cromwell CT 06416-2442 |
| Practice Telephone | 8608942933 |
| Practice Fax Number | 8608281610 |
| Mailing Telephone | 8608942933 |
| Mailing Fax Number | 8608281610 |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2019-07-18 |
| Authorized Official Name | DR. MICHAEL MAROON (MANAGING MEMBER/OWNER) |
| Authorized Official Telephone | 8608942933 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
CT006968 | CT | Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | ADVANCED DENTAL OF CROMWELL LLC | 39 Webster Square Rd, Berlin, CT 06037 |
| Street Address |
26 SHUNPIKE RD STE A |
| City | CROMWELL |
| State | CT |
| Zip Code | 06416-2442 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104469626 | Anjali Rowe | Developmental Therapist | 162 West Street., Building 2 Suite F, Building 2 Suite F, Cromwell, CT 06416 | 2019-10-28 |
| 1366938110 | Katherine Sluti | Developmental Therapist | 162 West St., Building 2 Suite F, Cromwell, CT 06416 | 2018-07-05 |
| 1821597477 | Sherry Wong | Behavioral Analyst | 162 West St, Bldg 2, Suite F, Cromwell, CT 06416 | 2018-02-09 |
| 1952826828 | Marlene Dejesus | Developmental Therapist | 162 West St, Bldg 2 Suite F, Cromwell, CT 06416 | 2017-08-11 |
| 1689199895 | Amanda Marie Mimande | Developmental Therapist | 162 West Street, Building 2, Suite F, Cromwell, CT 06416 | 2017-08-08 |
| 1912260357 | Ulrich Klaus Rathey | Internal Medicine | 2316 Cromwell Hills Drive, Cromwell, CT 06416 | 2012-06-20 |
| 1801171616 | Leonard J Zgorski | Pharmacist | 4 Hammerhead Place, Cromwell, CT 06416 | 2011-10-13 |
| 1396024725 | Michelle Nwigwe | Nurse Practitioner | 80 Shunpike Rd Ste 101-b2, Cromwell, CT 06416 | 2011-08-16 |
| 1508090028 | Giovanna Maria Cammuso | Social Worker | 22 Tuttle Road, Cromwell, CT 06416 | 2009-05-12 |
| 1992954994 | Connecticut Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 72 Berlin Rd., Cromwell, CT 06416 | 2008-09-15 |
| Find all providers in zip 06416 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063802221 | Benjanin M Frank | Dentist | 105 A Newton Road, Suite 4, Danbury, CT 06810-1603 | 2015-01-27 |
| 1801133293 | Ajay Kumar Dhingra | Dentist | 263 Farmington Ave Rm L6053, Farmington, CT 06030-1615 | 2013-01-06 |
| 1093085144 | Joel M Leon | Dentist | 138 Milbank Ave, Greenwich, CT 06830-6626 | 2012-01-06 |
| 1477751758 | Guillermo Zapata | Dentist | 25 Glenbrook Rd, Apt. 534, Stamford, CT 06902-2871 | 2007-07-06 |
| 1366651663 | Gary Edward Horblitt | Dentist | 2226 Black Rock Tpke, Fairfield, CT 06825 | 2007-05-22 |
| 1831304930 | Andrew Joseph Ponichtera | Dentist | 373 Hopmeadow St, Weatogue, CT 06089-9717 | 2007-05-11 |
| 1326268020 | Ervin Braun | Dentist | 24 Old Kings Hwy S, Darien, CT 06820-4537 | 2007-04-26 |
| 1447479233 | Dimitri Perdikis | Dentist | 820 Farmington Ave, West Hartford, CT 06119-1506 | 2007-04-24 |
| 1699822155 | Diane Elizabeth Gawronski | Dentist | 14 Westbrook Rd, Centerbrook, CT 06409 | 2007-01-05 |
| 1346305802 | Thomas D. Taylor | Dentist | Uconn Health Ctr, 263 Farmington Avenue, Mc-3915, Farmington, CT 06030-3915 | 2006-12-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.