Bolton Lake Dental LLC
Organization Active NPI Dental Clinic/Center · Bolton, CT
NPI 1194357418 · NPPES record last updated Feb 5, 2020
Key facts
- NPI
- 1194357418
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- Legal business name
- BOLTON LAKE DENTAL LLC
- Practice address
- 1120 Boston Tpke
Bolton, CT 06043-7439 - Phone
- (860) 646-3003
- NPI assigned
- Feb 5, 2020
- Organization subpart
- No
Authorized official
- Name
- Dr. Cristina Ilies, DDS
- Title
- Owner
- Phone
- (860) 646-3003
Practitioners 1
National Provider Directory
Locations
1120 Boston Tpke
Bolton, CT 06043
Phone (860) 646-3003
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Yes |
Addresses
Primary practice location
1120 Boston Tpke
Bolton, CT 06043-7439
Mailing address
1120 Boston Tpke
Bolton, CT 06043-7439
Phone (860) 646-3003
Other providers in Bolton, CT
- Michelle Anzures
- Bolton Board of Education
- Bolton Pharmacy Inc
- Bolton Physical Therapy & Sports Performance LLC
- Megan A Bouffard
- Monique Marie Brunelle
- Ronald L Buckman
All providers in Bolton, CT · Dental Clinic/Center in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.