Healthcare Provider Details

I. General information

NPI: 1770935710
Provider Name (Legal Business Name): TEE-PEE DENTISTRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 CLINTON AVE
BRIDGEPORT CT
06605-1713
US

IV. Provider business mailing address

468 CLINTON AVE
BRIDGEPORT CT
06605-1713
US

V. Phone/Fax

Practice location:
  • Phone: 203-337-6266
  • Fax: 203-337-6261
Mailing address:
  • Phone: 203-337-6266
  • Fax: 203-337-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number010779
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number10779
License Number StateCT

VIII. Authorized Official

Name: DR. JOHN E POWE
Title or Position: PRESIDENT
Credential: DDS
Phone: 347-909-2101