Healthcare Provider Details

I. General information

NPI: 1194963348
Provider Name (Legal Business Name): WENDY BUCKMIR KOVACS R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 OLD POST RD
FAIRFIELD CT
06824-6684
US

IV. Provider business mailing address

200 LANTERN RD
STRATFORD CT
06614-1301
US

V. Phone/Fax

Practice location:
  • Phone: 203-256-3020
  • Fax: 203-254-8850
Mailing address:
  • Phone: 203-378-8138
  • Fax: 203-254-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number003767
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: