NPIMap

Organization Active NPI

Glastonbury Dental Associates LLP

  • General Practice Dentistry
  • Glastonbury, CT
National Provider Identifier
1427189893
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GLASTONBURY DENTAL ASSOCIATES LLP
Practice address
416 New London Tpke
Glastonbury, CT 06033-2237
Phone
(860) 633-3671
Fax
(860) 633-9128
NPI assigned
Mar 8, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jonathan C Susat, DDSNPI 1073644159
Title
Partner
Phone
(860) 633-3671

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

416 New London Tpke
Glastonbury, CT 06033-2237

Mailing address

416 New London Tpke
Glastonbury, CT 06033-2237
Phone (860) 633-3671

Other identifiers 2

IdentifierTypeStateIssuer
Z12996OtherCTBC MA PROVIDER ID-GROUP
20772-1OtherCTUHC-GROUP

National Provider Directory

National Provider Directory

Locations

416 New London Tpke
Glastonbury, CT 06033
Phone (860) 633-3671

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": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427189893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 NEW LONDON TPKE",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332237",
            "telephone_number": "860-633-3671",
            "fax_number": "860-633-9128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 NEW LONDON TPKE",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332237",
            "telephone_number": "860-633-3671",
            "fax_number": "860-633-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLASTONBURY DENTAL ASSOCIATES LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SUSAT",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "860-633-3671",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC MA PROVIDER ID-GROUP",
            "identifier": "Z12996",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC-GROUP",
            "identifier": "20772-1",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glastonbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.