NPIMap

Organization Active NPI

Enfield Pediatric Dentistry LLC

  • Pediatric Dentistry
  • Enfield, CT
National Provider Identifier
1790068500
Registry record updated Sep 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
010105 Issued in CT
Legal business name
ENFIELD PEDIATRIC DENTISTRY LLC
Practice address
233 Hazard Avenue
Enfield, CT 06082
Phone
(860) 749-6622
NPI assigned
Sep 28, 2011
Last updated
Sep 28, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2011

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

Authorized official

Name
Toni L Russo, DMDNPI 1457565707
Title
Owner
Phone
(860) 749-6622

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 010105 CT Primary

Addresses

Primary practice location

233 Hazard Avenue
Enfield, CT 06082

Mailing address

233 Hazard Avenue
Enfield, CT 06082
Phone (860) 749-6622

National Provider Directory

National Provider Directory

Locations

233 Hazard Ave
Enfield, CT 06082
Phone (860) 749-6622

Practitioners & affiliated clinicians

Practitioners 2

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": "1317168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317168000000",
    "number": "1790068500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 HAZARD AVENUE",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "06082",
            "telephone_number": "860-749-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 HAZARD AVENUE",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "06082",
            "telephone_number": "860-749-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENFIELD PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-28",
        "last_updated": "2011-09-28",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "TONI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-749-6622",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "010105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; 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.