Healthcare Provider Details

I. General information

NPI: 1619803178
Provider Name (Legal Business Name): STAMFORD DENTAL SLEEP SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 BROAD ST
STAMFORD CT
06901-2702
US

IV. Provider business mailing address

124 BROAD ST
STAMFORD CT
06901-2702
US

V. Phone/Fax

Practice location:
  • Phone: 203-324-7777
  • Fax:
Mailing address:
  • Phone:
  • 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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MAMTA PATEL
Title or Position: OWNER
Credential: DDS
Phone: 203-324-7777