NPIMap

Organization Active NPI

Canton Valley Dental LLC

  • General Practice Dentistry
  • Canton, CT
National Provider Identifier
1154560118
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9636 Issued in CT
Legal business name
CANTON VALLEY DENTAL LLC
Practice address
191 Albany Tpke
Canton, CT 06019-2554
Phone
(860) 693-0887
Fax
(860) 693-1079
NPI assigned
Feb 16, 2009
Last updated
Sep 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

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

Authorized official

Name
Dr. Matthew Keefe, DMDNPI 1073734505
Title
Dentist/Partner
Phone
(860) 693-0887

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 9636 CT Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 8462 CT
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 5137 CT

Addresses

Primary practice location

191 Albany Tpke
Canton, CT 06019-2554

Mailing address

PO Box 456
Canton, CT 06019-0456
Phone (860) 693-0887

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1234742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631145600000",
    "number": "1154560118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 456",
            "city": "CANTON",
            "state": "CT",
            "postal_code": "060190456",
            "telephone_number": "860-693-0887",
            "fax_number": "860-693-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 ALBANY TPKE",
            "city": "CANTON",
            "state": "CT",
            "postal_code": "060192554",
            "telephone_number": "860-693-0887",
            "fax_number": "860-693-1079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON VALLEY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-16",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "KEEFE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DENTIST/PARTNER",
        "authorized_official_telephone_number": "860-693-0887",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "9636",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "8462",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "5137",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; 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.