Provider Demographics
NPI:1902294713
Name:REGENCY FAMILY DENTAL
Entity Type:Organization
Organization Name:REGENCY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHROTRIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-216-3377
Mailing Address - Street 1:1 STRAWBERRY HILL CT
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2548
Mailing Address - Country:US
Mailing Address - Phone:203-323-1186
Mailing Address - Fax:
Practice Address - Street 1:1 STRAWBERRY HILL CT
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2548
Practice Address - Country:US
Practice Address - Phone:203-323-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9984261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental