Provider Demographics
NPI:1285953653
Name:BRISTOL PLAZA FAMILY DENTAL
Entity type:Organization
Organization Name:BRISTOL PLAZA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-223-2000
Mailing Address - Street 1:1192 FARMINGTON AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1192 FARMINGTON AVE
Practice Address - Street 2:UNIT D
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4752
Practice Address - Country:US
Practice Address - Phone:860-223-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty