MEDICARE: PRIME DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1275884991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME DENTAL LLC

Provider Business Mailing Address
First Line	:	249 W MAIN ST STE 15
Second Line	:
City	:	BRANFORD
State	:	CT
Zip	:	06405-4048
Country	:	US
Telephone Number	:	203-691-6145
Fax Number	:	203-691-5515

Provider Business Practice Location Address
First Line	:	249 W MAIN ST STE 15
Second Line	:
City	:	BRANFORD
State	:	CT
Zip	:	06405-4048
Country	:	US
Telephone Number	:	203-691-6145
Fax Number	:	203-691-5515

Authorized Official
Title or Position	:	DENTIST
Name	:	IFFAT NAZNEEN
Credential	:
Telephone Number	:	203-691-6145

Provider Enumeration Date	:	09/20/2012
Last Update Date	:	04/16/2026

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Directions to “PRIME DENTAL LLC ” Practice Location

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