Healthcare Provider Details

I. General information

NPI: 1447165634
Provider Name (Legal Business Name): DOWNTOWN DENTAL GROUP OF STRATFORD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BARNUM AVE
STRATFORD CT
06614-4954
US

IV. Provider business mailing address

1100 BARNUM AVE
STRATFORD CT
06614-4954
US

V. Phone/Fax

Practice location:
  • Phone: 203-378-2760
  • Fax: 203-378-2759
Mailing address:
  • Phone: 203-378-2760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. YULIAN AMINOV
Title or Position: OWNER
Credential: DDS
Phone: 212-203-1611