Healthcare Provider Details

I. General information

NPI: 1326424995
Provider Name (Legal Business Name): PRINCEPS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 WHALLEY AVE
NEW HAVEN CT
06515-1728
US

IV. Provider business mailing address

881 WHALLEY AVE
NEW HAVEN CT
06515-1728
US

V. Phone/Fax

Practice location:
  • Phone: 203-691-5389
  • Fax:
Mailing address:
  • Phone: 203-691-5389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: NANCY MAZZINI
Title or Position: MANAGER
Credential:
Phone: 203-691-5389