Blue Back Dental LLC
NPI #1174814495 in West Hartford, Connecticut
Provider Information
- NPI Number
- 1174814495
- Entity Type
- Organization
- Organization Name
- Blue Back Dental LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Apr 20, 2011
- Last Updated
- Apr 20, 2011
Practice Location
- Address
- 65 MEMORIAL RD STE 400
- City
- West Hartford
- State
- Connecticut
- ZIP Code
- 06107-4219
- Phone
- (860) 233-9300
Authorized Official
- Name
- KIRSTEN E CAPOZZI
- Title
- PRACTICE MANAGER
- Phone
- (860) 233-9300
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
| Dentist - Periodontics — Periodontics |
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