ADVANCED DENTAL OF CROMWELL LLC — NPI 1265942676 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in CROMWELL, CT)

CMS-1500 Box 24J / 33a • NPI

1265942676

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1223P0700X

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

26 SHUNPIKE RD STE A, CROMWELL, CT, 06416-2442

✓ 9-Digit EDI 837 ZIP+4 (06416-2442)

Practice Phone & Referral Fax

(860) 894-2933

Fax: (860) 828-1610

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1265942676 (ADVANCED DENTAL OF CROMWELL LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1265942676` (NPI-2 Organization / Facility)
Provider / Legal Name	ADVANCED DENTAL OF CROMWELL LLC
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223P0700X` (Dentist, Prosthodontics)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	26 SHUNPIKE RD STE A, CROMWELL, CT, 06416-2442
Practice Telephone / Fax	Tel: (860) 894-2933 \| Fax: (860) 828-1610
Administrative Mailing Address	26 SHUNPIKE RD STE A, CROMWELL, CT, 06416-2442
Enumeration & Last Sync	Enumerated: 2017-10-11 \| CMS Record Updated: 2019-07-18
Authorized Official	MICHAEL MAROON (Managing Member/Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

26 SHUNPIKE RD STE A, CROMWELL, CT, 06416-2442

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Plain-English Taxonomy & CMS Crosswalk (1223P0700X)

What Does Taxonomy Code 1223P0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223P0700X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADVANCED DENTAL OF CROMWELL LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`332B00000X` — Durable Medical Equipment & Medical Supplies Plain English: Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies	State: N/A \| License: `Verified` \| Primary: Secondary
`1223P0700X` — Dentist, Prosthodontics Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: CT \| License: `CT006968` \| Primary: Yes (Primary)

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ADVANCED DENTAL OF CROMWELL LLC (NPI #1265942676)