Provider Demographics
NPI:1043479199
Name:GEOFFREY M. DRAWBRIDGE, D.D.S., P.C.
Entity type:Organization
Organization Name:GEOFFREY M. DRAWBRIDGE, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DRAWBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-729-1697
Mailing Address - Street 1:577 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-2845
Mailing Address - Country:US
Mailing Address - Phone:203-729-1697
Mailing Address - Fax:203-729-0336
Practice Address - Street 1:577 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-2845
Practice Address - Country:US
Practice Address - Phone:203-729-1697
Practice Address - Fax:203-729-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT36431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty