NPIMap

Organization Active NPI

Middletown Dental Associates LLC

  • General Practice Dentistry
  • Middletown, CT
National Provider Identifier
1073695466
Registry record updated Sep 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
008252 Issued in CT
Legal business name
MIDDLETOWN DENTAL ASSOCIATES LLC
Practice address
547 Main Street
Middletown, CT 06457-2806
Phone
(860) 346-3081
Fax
(860) 638-1123
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peter Gletzakos, DMD
Title
Owner
Phone
(860) 346-3081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 008252 CT Primary

Addresses

Primary practice location

547 Main Street
Middletown, CT 06457-2806

Mailing address

547 Main Street
Middletown, CT 06457-2806
Phone (860) 346-3081

National Provider Directory

National Provider Directory

Locations

547 Main St
Middletown, CT 06457
Phone (860) 346-3081

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380326400000",
    "number": "1073695466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "547 MAIN STREET",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572806",
            "telephone_number": "860-346-3081",
            "fax_number": "860-638-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "547 MAIN STREET",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572806",
            "telephone_number": "860-346-3081",
            "fax_number": "860-638-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLETOWN DENTAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2013-09-28",
        "status": "A",
        "authorized_official_last_name": "GLETZAKOS",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-346-3081",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "008252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.