Provider Demographics
NPI:1871963280
Name:WALNUT DENTAL
Entity type:Organization
Organization Name:WALNUT DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANNETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TEDONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-539-1973
Mailing Address - Street 1:80 TOWN LINE RD STE 7B
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1249
Mailing Address - Country:US
Mailing Address - Phone:860-257-4000
Mailing Address - Fax:860-257-4100
Practice Address - Street 1:80 TOWN LINE RD STE 7B
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1249
Practice Address - Country:US
Practice Address - Phone:860-257-4000
Practice Address - Fax:860-257-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty