Healthcare Provider Details

I. General information

NPI: 1013909654
Provider Name (Legal Business Name): CHILDREN'S DENTAL ASSOCIATES OF HAMDEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 WHITNEY AVE SUITE 270
HAMDEN CT
06518-3600
US

IV. Provider business mailing address

2080 WHITNEY AVE SUITE 270
HAMDEN CT
06518-3600
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-5825
  • Fax: 203-281-6731
Mailing address:
  • Phone: 203-281-5825
  • Fax: 203-281-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7502
License Number StateCT

VIII. Authorized Official

Name: DR. DOUGLAS JAMES MULLER
Title or Position: PRESIDENT
Credential: D.D.S
Phone: 203-281-5825