=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568609386
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOROTA BRYNDA-HANSEN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2009
-----------------------------------------------------
Last Update Date | 12/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 472 BOSTON POST RD STE 5
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06477-3518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-795-0330
-----------------------------------------------------
Fax | 203-795-6634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 472 BOSTON POST RD STE 5
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06477-3518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-795-0330
-----------------------------------------------------
Fax | 203-795-6634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 051676
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 010163
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------