Provider Demographics
NPI:1861937492
Name:AVON FAMILY AND COSMETIC DENTISTRY LLC
Entity type:Organization
Organization Name:AVON FAMILY AND COSMETIC DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-254-6955
Mailing Address - Street 1:39 E MAIN ST STE 3S
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3841
Mailing Address - Country:US
Mailing Address - Phone:860-674-0707
Mailing Address - Fax:860-678-8440
Practice Address - Street 1:39 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3841
Practice Address - Country:US
Practice Address - Phone:860-830-4711
Practice Address - Fax:860-254-6956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY ENFIELD DENTIST LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-06
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0101891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty