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General NPI Number Information
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NPI Number | 1295126209
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Entity Type | Organization
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Legal Business Name | ALL KIDS DENTAL LLC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 2566 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5302
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Country | US
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Telephone | 203-222-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 29 IMPERIAL AVE
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City | WESTPORT
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State | CT
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Zip | 06880-4303
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Country | US
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Telephone | 203-222-1444
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Fax | 203-222-0482
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EFREN CORTES
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Credential | DDS
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Telephone | 203-222-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 008345
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License Number State | CT
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