Bristol City Health Dept Dental Clinic

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

0401003521 Issued in VA

Legal business name

BRISTOL CITY HEALTH DEPT DENTAL CLINIC

Practice address

205 Piedmont Ave
Bristol, CT 24201

Phone

(276) 642-7335

Fax

(276) 642-7347

NPI assigned

Oct 27, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Anna H Stevens

Title

Business Manager

Phone

(276) 781-7450

Specialties & licenses 1

Addresses

Tax ID family

Dickenson Co Health Dep163 organizations share this tax ID, including this one

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093891806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 PIEDMONT AVE",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "24201",
            "telephone_number": "276-642-7335",
            "fax_number": "276-642-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 PIEDMONT AVE",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "24201",
            "telephone_number": "276-642-7335",
            "fax_number": "276-642-7347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL CITY HEALTH DEPT DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "276-781-7450",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "VA",
            "license": "0401003521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Public Health Dentistry in Bristol, CT
• Providers in Bristol, CT by specialty
• Public Health Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.