Healthcare Provider Details

I. General information

NPI: 1295936607
Provider Name (Legal Business Name): QUYNHCHI N VAN LANG DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 OLD KINGS HIGHWAY NORTH
DARIEN CT
06820
US

IV. Provider business mailing address

53 OLD KINGS HIGHWAY NORTH
DARIEN CT
06820
US

V. Phone/Fax

Practice location:
  • Phone: 203-655-8887
  • Fax: 203-655-0524
Mailing address:
  • Phone: 203-655-8887
  • Fax: 203-655-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ELIOT S ESSENFELD
Title or Position: DDS VICE PRESIDENT
Credential: DDS
Phone: 203-655-8887