Healthcare Provider Details

I. General information

NPI: 1043423593
Provider Name (Legal Business Name): FAMILY DENTAL GROUP FAIRFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 KINGS HWY E
FAIRFIELD CT
06825-4813
US

IV. Provider business mailing address

320 KINGS HWY E
FAIRFIELD CT
06825-4813
US

V. Phone/Fax

Practice location:
  • Phone: 203-337-6262
  • Fax: 203-337-6267
Mailing address:
  • Phone: 203-337-6262
  • Fax: 203-337-6267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9408
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5212
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8178
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number8552
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2582
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6481
License Number StateCT

VIII. Authorized Official

Name: DR. KENNETH M EPSTEIN
Title or Position: OWNER
Credential: D.D.S.
Phone: 203-337-6262