Healthcare Provider Details

I. General information

NPI: 1275278467
Provider Name (Legal Business Name): DENTAL SOLUTIONS KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 EAST AVE
NORWALK CT
06851-5712
US

IV. Provider business mailing address

169 EAST AVE
NORWALK CT
06851-5712
US

V. Phone/Fax

Practice location:
  • Phone: 917-365-0513
  • Fax:
Mailing address:
  • Phone: 917-365-0513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIAS ALTAGRACIA PIMENTEL
Title or Position: EMPLOYER
Credential: DMD
Phone: 917-365-0513