J Dental Group PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

J DENTAL GROUP PC

Practice address

1177 Silas Deane Hwy
Wethersfield, CT 06109-4348

Phone

(860) 563-6080

Fax

(860) 529-4420

NPI assigned

May 12, 2021

Organization subpart

No

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

Authorized official

Name

Tami Smith

Title

Credentialing Specialist

Phone

(317) 366-3595

Specialties & licenses 1

Addresses

Other names 1

• Wethersfield Dental Associates Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1487238705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1177 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094348",
            "telephone_number": "860-563-6080",
            "fax_number": "860-529-4420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1177 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094348",
            "telephone_number": "860-563-6080",
            "fax_number": "860-529-4420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J DENTAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-12",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "317-366-3595"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Direct",
            "affiliation": "N",
            "address_1": "1177 Silas Deane Hwy",
            "city": "Wethersfield",
            "state": "CT",
            "country_code": "US",
            "postal_code": "061094348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Wethersfield Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Charles Huston, MD
• Maryam Iftikhar
• Integrated Procare Services
• Intercommunity Mental Health Group
• J & L Medical Services
• Joanne Jacques
• Stacie L Jankowski, RDH
• Jean Richard Ladouceur
• Jenna Smith Aprn PLLC
• Jerome Glazer OD

• Dental Clinic/Center in Wethersfield, CT
• Providers in Wethersfield, CT by specialty
• Dental Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; 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.