NPIMap

Organization Active NPI

New London Dental Care, LLC

Doing business as New London Dental Care

  • General Practice Dentistry
  • New London, CT
National Provider Identifier
1629364997
Registry record updated Jun 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9920 Issued in CT
Legal business name
NEW LONDON DENTAL CARE, LLC
Doing business as
New London Dental Care
Practice address
258 S Frontage Rd
New London, CT 06320-2641
Phone
(860) 437-3462
Fax
(860) 437-3485
NPI assigned
Jun 24, 2011
Last updated
Jun 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2014

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

Authorized official

Name
Diane Devries
Title
Business Manager
Phone
(860) 342-4141

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 9920 CT Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X

Addresses

Primary practice location

258 S Frontage Rd
New London, CT 06320-2641

Mailing address

553 Portland Cobalt Rd
Portland, CT 06480-1968
Phone (860) 342-4141

Other names 1

  • New London Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

258 S Frontage Rd
New London, CT 06320
Phone (860) 347-3485

Practitioners & affiliated clinicians

Practitioners 6

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": "1308873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402012800000",
    "number": "1629364997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 PORTLAND COBALT RD",
            "city": "PORTLAND",
            "state": "CT",
            "postal_code": "064801968",
            "telephone_number": "860-342-4141",
            "fax_number": "860-342-1284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 S FRONTAGE RD",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063202641",
            "telephone_number": "860-437-3462",
            "fax_number": "860-437-3485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LONDON DENTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-24",
        "last_updated": "2014-06-06",
        "status": "A",
        "authorized_official_last_name": "DEVRIES",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "860-342-4141"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "9920",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New London Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New London, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2014; 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.