Provider Demographics
NPI:1871709725
Name:ESSENTIAL DENTAL, LLC
Entity type:Organization
Organization Name:ESSENTIAL DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:BARDEN
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-426-0997
Mailing Address - Street 1:1090 MERIDEN WATERBURY TPKE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479
Mailing Address - Country:US
Mailing Address - Phone:860-426-0997
Mailing Address - Fax:860-426-0669
Practice Address - Street 1:1090 MERIDEN WATERBURY TPKE
Practice Address - Street 2:SUITE 2
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479
Practice Address - Country:US
Practice Address - Phone:860-426-0997
Practice Address - Fax:860-426-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty