Healthcare Provider Details

I. General information

NPI: 1205592557
Provider Name (Legal Business Name): ASNIS DENTAL OF CONNECTICUT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 OAK ST STE 240
STAMFORD CT
06905-5345
US

IV. Provider business mailing address

105 MAXESS RD STE 107N
MELVILLE NY
11747-3859
US

V. Phone/Fax

Practice location:
  • Phone: 203-252-2252
  • Fax: 631-396-0452
Mailing address:
  • Phone: 631-414-7927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN LIEBLING
Title or Position: COO
Credential:
Phone: 631-414-7927