Provider Demographics
NPI:1053795070
Name:ORANGE CENTER DENTISTRY PC
Entity type:Organization
Organization Name:ORANGE CENTER DENTISTRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:COGGUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:475-777-5108
Mailing Address - Street 1:676 NEW HAVEN AVE
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2500
Mailing Address - Country:US
Mailing Address - Phone:475-777-5108
Mailing Address - Fax:475-777-5118
Practice Address - Street 1:676 NEW HAVEN AVE
Practice Address - Street 2:SUITE A-3
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-2500
Practice Address - Country:US
Practice Address - Phone:475-777-5108
Practice Address - Fax:475-777-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty