Provider Demographics
NPI:1831278811
Name:SEROW, MICHAEL P (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:SEROW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:281 HARTFORD TURNPIKE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066
Mailing Address - Country:US
Mailing Address - Phone:860-871-2618
Mailing Address - Fax:860-872-9477
Practice Address - Street 1:281 HARTFORD TURNPIKE
Practice Address - Street 2:SUITE 205
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:860-871-2618
Practice Address - Fax:860-872-9477
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT41241223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223E0200XDental ProvidersDentistEndodontics
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
020004124CT01OtherANTHEM BLUE CROSS
458860OtherUNITED CONCORDIA
8611OtherDELTA DENTAL
52411OtherDENTAL BENEFITS PROVIDERS