NPIMap

Organization Active NPI

Advantage Dental Group, LLC

  • General Practice Dentistry
  • East Lyme, CT
National Provider Identifier
1568674331
Registry record updated Sep 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7928 Issued in CT
Legal business name
ADVANTAGE DENTAL GROUP, LLC
Practice address
339 Flanders Rd
Suite 105
East Lyme, CT 06333
Phone
(860) 691-0025
NPI assigned
May 4, 2007
Last updated
Sep 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2009

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

Authorized official

Name
Erin R Van Lew
Title
Office Manager
Phone
(860) 691-0025

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 7928 CT Primary

Addresses

Primary practice location

339 Flanders Rd
Suite 105
East Lyme, CT 06333

Mailing address

339 Flanders Rd
Suite 105
East Lyme, CT 06333
Phone (860) 691-0025

National Provider Directory

National Provider Directory
Tax ID family
Advantage Dental Group LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

339 Flanders Rd
Ste 105
East Lyme, CT 06333
Phone (860) 691-0025

Practitioners & affiliated clinicians

Practitioners 3

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": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253836800000",
    "number": "1568674331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 FLANDERS RD",
            "address_2": "SUITE 105",
            "city": "EAST LYME",
            "state": "CT",
            "postal_code": "06333",
            "telephone_number": "860-691-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 FLANDERS RD",
            "address_2": "SUITE 105",
            "city": "EAST LYME",
            "state": "CT",
            "postal_code": "06333",
            "telephone_number": "860-691-0025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2009-09-25",
        "status": "A",
        "authorized_official_last_name": "VAN LEW",
        "authorized_official_first_name": "ERIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "860-691-0025"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "7928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lyme, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2009; 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.