Provider Demographics
NPI:1902576101
Name:LITCHFIELD DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LITCHFIELD DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDERIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-567-9488
Mailing Address - Street 1:P.O. BOX 414
Mailing Address - Street 2:63 WEST STREET
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759
Mailing Address - Country:US
Mailing Address - Phone:860-567-9488
Mailing Address - Fax:860-567-4365
Practice Address - Street 1:63 WEST STREET
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759
Practice Address - Country:US
Practice Address - Phone:860-567-9488
Practice Address - Fax:860-567-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty