Provider Demographics
NPI:1174049373
Name:ADVANCE DENTAL UNIONVILLE PC
Entity type:Organization
Organization Name:ADVANCE DENTAL UNIONVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAYAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-336-9767
Mailing Address - Street 1:15 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1277
Practice Address - Country:US
Practice Address - Phone:860-673-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental