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General NPI Number Information
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NPI Number | 1326424995
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Entity Type | Organization
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Legal Business Name | PRINCEPS HEALTHCARE
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 881 WHALLEY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06515-1728
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Country | US
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Telephone | 203-691-5389
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Fax |
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Provider Business Mailing Address
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Address Line | 881 WHALLEY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06515-1728
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Country | US
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Telephone | 203-691-5389
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NANCY MAZZINI
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Credential |
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Telephone | 203-691-5389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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