NPIMap

Organization Active NPI

Robert J. Mailloux DMD

  • General Practice Dentistry
  • Hartford, CT
National Provider Identifier
1902053531
Registry record updated Jul 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5868 Issued in CT
Legal business name
ROBERT J. MAILLOUX DMD
Practice address
397 New Britain Ave
Hartford, CT 06106-3833
Phone
(860) 247-1021
Fax
(860) 724-2379
NPI assigned
Aug 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2011

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

Authorized official

Name
Dr. Robert J. Mailloux, DMDNPI 1083602916
Title
Owner
Phone
(860) 247-1021

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5868 CT Primary

Addresses

Primary practice location

397 New Britain Ave
Hartford, CT 06106-3833

Mailing address

397 New Britain Ave
Hartford, CT 06106-3833
Phone (860) 247-1021

Other identifiers 2

IdentifierTypeStateIssuer
002058683MedicaidCT
008001793MedicaidCT

National Provider Directory

National Provider Directory

Locations

397 New Britain Ave
Hartford, CT 06106
Phone (860) 246-1021

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309824000000",
    "number": "1902053531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "397 NEW BRITAIN AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063833",
            "telephone_number": "860-247-1021",
            "fax_number": "860-724-2379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "397 NEW BRITAIN AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063833",
            "telephone_number": "860-247-1021",
            "fax_number": "860-724-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT J. MAILLOUX DMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-26",
        "last_updated": "2011-07-05",
        "status": "A",
        "authorized_official_last_name": "MAILLOUX",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-247-1021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "5868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002058683",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008001793",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.