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General NPI Number Information
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NPI Number | 1538207295
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Entity Type | Organization
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Legal Business Name | BRIDGEPORT FAMILY HEALTH LLC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 1381 RESERVOIR AVENUE
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City | BRIDGEPORT
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State | CT
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Zip | 06606-2502
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Country | US
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Telephone | 203-371-5197
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Fax | 203-371-6118
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Provider Business Mailing Address
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Address Line | 1381 RESERVOIR AVENUE
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City | BRIDGEPORT
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State | CT
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Zip | 06606-2502
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Country | US
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Telephone | 203-371-5197
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Fax | 203-371-6118
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DENNIS J WILLIAMS
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Credential | M.D.
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Telephone | 203-371-5197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 030225
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License Number State | CT
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