Terryville Family Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TERRYVILLE FAMILY DENTAL, LLC

Practice address

14 Maple St
Terryville, CT 06786-5220

Phone

(860) 853-3582

Fax

(860) 582-8654

NPI assigned

Aug 28, 2016

Organization subpart

No

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

Authorized official

Name

Kosha Shah, DDS

Title

Owner

Phone

(860) 583-3582

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472342400000",
    "number": "1831645167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MAPLE ST",
            "city": "TERRYVILLE",
            "state": "CT",
            "postal_code": "067865220",
            "telephone_number": "860-853-3582",
            "fax_number": "860-582-8654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MAPLE ST",
            "city": "TERRYVILLE",
            "state": "CT",
            "postal_code": "067865220",
            "telephone_number": "860-853-3582",
            "fax_number": "860-582-8654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TERRYVILLE FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2016-08-28",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "KOSHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-583-3582",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; 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.