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General NPI Number Information
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NPI Number | 1285867796
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Entity Type | Organization
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Legal Business Name | CONNECTIDENT, LLC
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 04/03/2014
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Provider Practice Location 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 | 860-528-3350
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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 | 860-528-3350
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. YOON JOONG ALLAN KWON
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Credential | DDS
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Telephone | 212-786-2187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10110
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License Number State | CT
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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 | 10004
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License Number State | CT
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