Provider Demographics
NPI:1730390352
Name:ELLINGTON DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:ELLINGTON DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:LLOIS
Authorized Official - Last Name:VALLERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-872-2452
Mailing Address - Street 1:175 WEST RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3730
Mailing Address - Country:US
Mailing Address - Phone:860-872-2452
Mailing Address - Fax:860-870-1385
Practice Address - Street 1:175 WEST RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3730
Practice Address - Country:US
Practice Address - Phone:860-872-2452
Practice Address - Fax:860-870-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT78691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty