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General NPI Number Information
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NPI Number | 1457493728
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF BRIDGEPORT
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 03/05/2014
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Provider Practice Location Address
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Address Line | 60 LAFAYETTE ST
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City | BRIDGEPORT
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State | CT
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Zip | 06604-7719
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Country | US
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Telephone | 203-576-4138
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Fax | 203-576-4220
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Provider Business Mailing Address
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Address Line | 60 LAFAYETTE ST
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City | BRIDGEPORT
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State | CT
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Zip | 06604-7719
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Country | US
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Telephone | 203-576-4138
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Fax | 203-576-4220
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Authorized Official
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Title or Position | V. P. ADMINISTRATION AND FINANCE
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Name | MS. SUSAN WILLIAMS
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Credential |
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Telephone | 203-576-4651
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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 | 0463
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License Number State | CT
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