Andrew Fennell
Individual provider Active NPI Dentist · Hebron, CT
NPI 1962898320 · NPPES record last updated Nov 20, 2018
Key facts
- NPI
- 1962898320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 11608 (CT)
- Practice address
- 20 Liberty Dr
Hebron, CT 06248 - Phone
- (860) 228-7878
- NPI assigned
- Apr 13, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161021001840 | CT | Order and Referring Only - Dentist |
7719265917 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11608 | CT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Andrew Fennell PLLC | Dentist | Current | Accepting new patients |
| Hebron Dentistry PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11608 | CT | Yes |
| General Practice Dentistry | 1223G0001X | 11608 | CT |
Addresses
Primary practice location
20 Liberty Dr
Hebron, CT 06248
Mailing address
20 Liberty Dr
Hebron, CT 06248-1552
Phone (860) 228-7878
Other practice location 1
490 South Broad Street
#19
Meriden, CT 06450
Phone (203) 237-1000 ext. 2
Other providers in Hebron, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.