Healthcare Provider Details

I. General information

NPI: 1073877197
Provider Name (Legal Business Name): MIN DENG D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CHURCH ST
YALESVILLE CT
06492-2340
US

IV. Provider business mailing address

60 CHURCH ST
YALESVILLE CT
06492-2340
US

V. Phone/Fax

Practice location:
  • Phone: 203-774-0019
  • Fax:
Mailing address:
  • Phone: 203-774-0019
  • Fax: 203-774-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number010929
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: