Edward Robert Boothroyd, D.M.D.
Individual provider Active NPI Dentist · Middletown, CT
NPI 1972707321 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1972707321
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 006479 (CT)
- Practice address
- 157 Saybrook Rd
Middletown, CT 06457-4704 - Phone
- (860) 347-1546
- NPI assigned
- Jun 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006479 | CT | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 006479 | CT | Yes |
Addresses
Primary practice location
157 Saybrook Rd
Middletown, CT 06457-4704
Mailing address
12 Country Walk
Higganum, CT 06441-4400
Phone (860) 345-7422
Other providers in Middletown, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.