Healthcare Provider Details

I. General information

NPI: 1043576085
Provider Name (Legal Business Name): W.H. HAMPTONS DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 S MAIN ST STE 312
WEST HARTFORD CT
06107-2486
US

IV. Provider business mailing address

61 S MAIN ST STE 312
WEST HARTFORD CT
06107-2486
US

V. Phone/Fax

Practice location:
  • Phone: 860-521-3177
  • Fax:
Mailing address:
  • Phone: 860-521-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateCT

VIII. Authorized Official

Name: YOON JOONG ALLAN KWON
Title or Position: MEMBER
Credential:
Phone: 212-786-2187