=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215735022
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORWALK DDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2025
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 72 NEWTOWN AVE
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06851-3025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-786-1132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 CAMBRIDGE ST
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06824-6905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-786-1132
-----------------------------------------------------
Fax | 816-786-1132
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KOLE KRASNIQI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 816-786-1132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------