Healthcare Provider Details

I. General information

NPI: 1497283022
Provider Name (Legal Business Name): NORWALK FAMILY DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CHESTNUT HILL RD
NORWALK CT
06851-2524
US

IV. Provider business mailing address

26 CHESTNUT HILL RD
NORWALK CT
06851-2524
US

V. Phone/Fax

Practice location:
  • Phone: 203-846-3251
  • Fax: 203-846-3870
Mailing address:
  • Phone: 203-846-3251
  • Fax: 203-846-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number11707
License Number StateCT

VIII. Authorized Official

Name: DR. NAZNEEN REHAN JAFFRI
Title or Position: PRESIDENT
Credential: DDS
Phone: 917-886-9048