Healthcare Provider Details

I. General information

NPI: 1508686320
Provider Name (Legal Business Name): CHILDRENS DENTAL HEALTH OF BRIDGEPORT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 MAIN ST STE 301
BRIDGEPORT CT
06606-3611
US

IV. Provider business mailing address

3715 MAIN ST STE 301
BRIDGEPORT CT
06606-3611
US

V. Phone/Fax

Practice location:
  • Phone: 609-712-0708
  • Fax:
Mailing address:
  • Phone: 609-712-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAGHBIR KAUR
Title or Position: DENTIST
Credential: DMD
Phone: 609-712-0708