NPIMap

Organization Active NPI

Mystic Dental Group, P.C.

  • General Practice Dentistry
  • Mystic, CT
National Provider Identifier
1376700997
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8531 Issued in CT
Legal business name
MYSTIC DENTAL GROUP, P.C.
Practice address
117 Cow Hill Rd
Mystic, CT 06355-1449
Phone
(860) 536-4951
NPI assigned
May 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2008

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

Authorized official

Name
Tara Cisco
Title
Manager
Phone
(860) 536-4951

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 8531 CT Primary

Addresses

Primary practice location

117 Cow Hill Rd
Mystic, CT 06355-1449

Mailing address

117 Cow Hill Rd
Mystic, CT 06355-1449

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1376700997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 COW HILL RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 COW HILL RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551449",
            "telephone_number": "860-536-4951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC DENTAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "CISCO",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "860-536-4951"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "8531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mystic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; 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.