Healthcare Provider Details

I. General information

NPI: 1154551372
Provider Name (Legal Business Name): DURGESH ANIL KUDCHADKAR D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SUMMER ST DENTAL CARE KIDS OF STAMFORD
STAMFORD CT
06905-5132
US

IV. Provider business mailing address

33 N WATER ST UNIT 707
NORWALK CT
06854-2557
US

V. Phone/Fax

Practice location:
  • Phone: 203-883-4431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number055401
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number010074
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: