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General NPI Number Information
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NPI Number | 1467130757
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Entity Type | Individual
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Provider Name | NATASHA K FANSIWALA DMD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 80 GROVE ST
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City | RIDGEFIELD
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State | CT
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Zip | 06877-4104
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Country | US
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Telephone | 203-431-4344
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Fax |
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Provider Business Mailing Address
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Address Line | 101 WASHINGTON ST UNIT 205
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City | NORWALK
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State | CT
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Zip | 06854-3078
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Country | US
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Telephone | 518-879-9621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 04854
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License Number State | NH
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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 | 14321
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License Number State | CT
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