Provider Demographics
NPI:1588774681
Name:ALBERT, MICHAEL CARL (RDH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CARL
Last Name:ALBERT
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:CARL
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:36 ROYAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:860-584-1287
Mailing Address - Fax:
Practice Address - Street 1:359 FARMINGTON AVE
Practice Address - Street 2:CENTRAL CT DENTAL GROUP
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062
Practice Address - Country:US
Practice Address - Phone:860-747-5761
Practice Address - Fax:860-747-6964
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006109124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist