483 Middle Tpke W, Suite 309, Manchester, CT 06040
Phone
(860) 645-0111
Listed under
Prosthodontists
NPI
1073741104
NPI status
Active in the NPPES registry
Provider type
Individual provider
Registered specialty (self-reported taxonomy)
Prosthodontics (1223P0700X)
Credentials listed
DMD
License number on NPI record
11042 (CT)
NPI first issued
Jun 26, 2009
NPI record last updated
Aug 22, 2013
NPI 1073741104 is active in the federal NPPES registry (CMS) with Prosthodontics, an ADA-recognized dental specialty, as its primary taxonomy; license 11042 (CT) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-09-30.
What these registry facts mean
The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Prosthodontists specialize in restoring and replacing teeth: crowns, bridges, dentures and the teeth that go on top of implants, including full-arch fixed bridges. Dentists who are not specialists can also place implants; the specialty here is the one the provider registered as primary.
Checking credentials: the specialty shown is the one this provider registered with the NPI system. Your state dental board's license lookup confirms the license, and the American Board of Prosthodontics, the American Board of Oral and Maxillofacial Surgery and the American Board of Periodontology each list their board-certified members.