Healthcare Provider Details

I. General information

NPI: 1427238302
Provider Name (Legal Business Name): ALBANA VEDAT LAME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALBANA VEDAT KULLA

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PHOENIX AVE
WATERBURY CT
06702-1418
US

IV. Provider business mailing address

33 POLK AVE
WATERBURY CT
06708-4220
US

V. Phone/Fax

Practice location:
  • Phone: 203-756-8021
  • Fax: 203-596-9038
Mailing address:
  • Phone: 203-753-7914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number006457
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: