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General NPI Number Information
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NPI Number | 1033622246
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Entity Type | Organization
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Legal Business Name | MAGICLAND PEDIATRIC DENTAL LLC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 1141 WOLCOTT ST
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City | WATERBURY
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State | CT
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Zip | 06705-1318
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Country | US
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Telephone | 860-282-0630
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 MAIN ST
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City | EAST HARTFORD
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State | CT
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Zip | 06108-2294
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CHIA HUI JENNY KWON
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Credential | DDS
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Telephone | 917-453-4055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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