Healthcare Provider Details

I. General information

NPI: 1295639730
Provider Name (Legal Business Name): BROOKFIELD DENTAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 FEDERAL RD
BROOKFIELD CT
06804-2017
US

IV. Provider business mailing address

25 N LEXINGTON AVE APT 1212
WHITE PLAINS NY
10601-1760
US

V. Phone/Fax

Practice location:
  • Phone: 203-740-1014
  • Fax:
Mailing address:
  • Phone: 917-744-7129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUNG HYON HAN
Title or Position: OWNER
Credential: DMD
Phone: 917-744-7129