Provider Demographics
NPI:1356551865
Name:DENTAL SOLUTIONS OF GLASTONBURY
Entity type:Organization
Organization Name:DENTAL SOLUTIONS OF GLASTONBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-633-0486
Mailing Address - Street 1:127 HAYSTACK ROAD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-646-1344
Mailing Address - Fax:860-659-2126
Practice Address - Street 1:131 NEW LONDON TPKE
Practice Address - Street 2:SUITE 211
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2246
Practice Address - Country:US
Practice Address - Phone:860-633-0486
Practice Address - Fax:860-659-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT85561223G0001X
CT48621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty