Advanced Dental of Cromwell LLC

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

CT006968 Issued in CT

Legal business name

ADVANCED DENTAL OF CROMWELL LLC

Practice address

26 Shunpike Rd Ste a
Cromwell, CT 06416-2442

Phone

(860) 894-2933

Fax

(860) 828-1610

NPI assigned

Oct 11, 2017

Last updated

Jul 18, 2019By 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

Dr. Michael Maroon, DMD

Title

Managing Member/Owner

Phone

(860) 894-2933

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1265942676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 SHUNPIKE RD STE A",
            "city": "CROMWELL",
            "state": "CT",
            "postal_code": "064162442",
            "telephone_number": "860-894-2933",
            "fax_number": "860-828-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 SHUNPIKE RD STE A",
            "city": "CROMWELL",
            "state": "CT",
            "postal_code": "064162442",
            "telephone_number": "860-894-2933",
            "fax_number": "860-828-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL OF CROMWELL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-11",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "MAROON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER/OWNER",
        "authorized_official_telephone_number": "860-894-2933",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CT",
            "license": "CT006968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.