Provider Demographics
NPI:1528070026
Name:FAMILY DENTAL CENTER OF CONNECTICUT
Entity type:Organization
Organization Name:FAMILY DENTAL CENTER OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZORICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-763-5522
Mailing Address - Street 1:150 HAZARD AVE
Mailing Address - Street 2:UNIT C3
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-763-5522
Mailing Address - Fax:860-763-5521
Practice Address - Street 1:150 HAZARD AVE
Practice Address - Street 2:UNIT C3
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-763-5522
Practice Address - Fax:860-763-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009016122300000X
CT009052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty