NPIMap

Organization Active NPI

Children's Dental Associates of NLC, PC

  • Pediatric Dentistry
  • Bozrah, CT
National Provider Identifier
1225028657
Registry record updated Jan 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
CHILDREN'S DENTAL ASSOCIATES OF NLC, PC
Practice address
392 Salem Tpke
Bozrah, CT 06334-1519
Phone
(860) 886-5576
Fax
(860) 885-1379
NPI assigned
Oct 26, 2005
Last updated
Jan 11, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2011

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

Authorized official

Name
Mrs. Michelle S Herter
Title
Manger
Phone
(860) 886-5576

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

392 Salem Tpke
Bozrah, CT 06334-1519

Mailing address

392 Salem Tpke
Bozrah, CT 06334-1519
Phone (860) 886-5576

Other identifiers 1

IdentifierTypeStateIssuer
004119211MedicaidCT

National Provider Directory

National Provider Directory

Locations

392 Salem Tpke
Bozrah, CT 06334
Phone (860) 886-5576

Practitioners & affiliated clinicians

Practitioners 4

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": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294704000000",
    "number": "1225028657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "392 SALEM TPKE",
            "city": "BOZRAH",
            "state": "CT",
            "postal_code": "063341519",
            "telephone_number": "860-886-5576",
            "fax_number": "860-885-1379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "392 SALEM TPKE",
            "city": "BOZRAH",
            "state": "CT",
            "postal_code": "063341519",
            "telephone_number": "860-886-5576",
            "fax_number": "860-885-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DENTAL ASSOCIATES OF NLC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2011-01-11",
        "status": "A",
        "authorized_official_last_name": "HERTER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANGER",
        "authorized_official_telephone_number": "860-886-5576",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004119211",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bozrah, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; 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.