Healthcare Provider Details

I. General information

NPI: 1023803731
Provider Name (Legal Business Name): FRANK AMAEFUNA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 ORANGE ST
NEW HAVEN CT
06511-6406
US

IV. Provider business mailing address

79 LAWRENCE ST APT 4
NEW HAVEN CT
06511-3180
US

V. Phone/Fax

Practice location:
  • Phone: 973-518-2401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14620
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: