Healthcare Provider Details

I. General information

NPI: 1346553658
Provider Name (Legal Business Name): KATHLEEN DUNN HUZA D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TECHNOLOGY DR UNIT C106
TRUMBULL CT
06611-6347
US

IV. Provider business mailing address

115 TECHNOLOGY DR UNIT C106
TRUMBULL CT
06611-6347
US

V. Phone/Fax

Practice location:
  • Phone: 203-445-6000
  • Fax: 475-231-1041
Mailing address:
  • Phone: 203-445-6000
  • Fax: 475-231-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12725
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number056013
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: