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General NPI Number Information
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NPI Number | 1326428889
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Entity Type | Organization
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Legal Business Name | CONNECTICUT CENTER FOR RESTORATIVE DENTISTRY
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Dates
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Enumeration Date | 05/31/2015
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Last Update Date | 05/31/2015
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Provider Practice Location Address
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Address Line | 202 WATER ST
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City | NAUGATUCK
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State | CT
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Zip | 06770-2843
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Country | US
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Telephone | 203-723-1901
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Fax |
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Provider Business Mailing Address
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Address Line | 202 WATER ST
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City | NAUGATUCK
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State | CT
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Zip | 06770-2843
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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. VICTOR CHUENG
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Credential |
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Telephone | 646-591-7895
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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 | 010593
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License Number State | CT
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