Provider Demographics
NPI:1124132600
Name:WINFIELD S DANIELSON JR DDS
Entity type:Organization
Organization Name:WINFIELD S DANIELSON JR DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-871-2875
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-0864
Mailing Address - Country:US
Mailing Address - Phone:860-871-2875
Mailing Address - Fax:860-871-2875
Practice Address - Street 1:642 TOLLAND STAGE RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-0864
Practice Address - Country:US
Practice Address - Phone:860-871-2875
Practice Address - Fax:860-871-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT36401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty