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General NPI Number Information
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NPI Number | 1538558622
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Entity Type | Organization
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Legal Business Name | CHILDRENS DENTISTRY OF TRUMBULL, PC
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 999 SILVER LN 2D
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City | TRUMBULL
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State | CT
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Zip | 06611-5343
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Country | US
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Telephone | 203-590-1588
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Fax |
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Provider Business Mailing Address
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Address Line | 5211 MADISON AVE
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City | TRUMBULL
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State | CT
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Zip | 06611-1040
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Country | US
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Telephone | 203-767-3798
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARA ISABEL YSAAC-GARCIA
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Credential | DMD
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Telephone | 203-767-3798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10994
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License Number State | CT
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