Provider Demographics
NPI:1366319808
Name:FAEDO, VOLMIR ANTONIO JR (ORTHODONTICS)
Entity type:Individual
Prefix:DR
First Name:VOLMIR
Middle Name:ANTONIO
Last Name:FAEDO
Suffix:JR
Gender:M
Credentials:ORTHODONTICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK PL
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5007
Mailing Address - Country:US
Mailing Address - Phone:860-816-6145
Mailing Address - Fax:
Practice Address - Street 1:135 DOWLING WAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty