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General NPI Number Information
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NPI Number | 1568700920
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Entity Type | Organization
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Legal Business Name | BRASS CITY DENTISTRY
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Dates
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Enumeration Date | 01/19/2013
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Last Update Date | 01/19/2013
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Provider Practice Location Address
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Address Line | 3670 E MAIN ST SUITE 10
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City | WATERBURY
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State | CT
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Zip | 06705-3851
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Country | US
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Telephone | 203-754-0184
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Fax |
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Provider Business Mailing Address
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Address Line | 211 POMEROY AVE UNIT 1102
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City | MERIDEN
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State | CT
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Zip | 06450-7165
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Country | US
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Telephone | 317-437-3221
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BILAL AHMED
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Credential | DDS
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Telephone | 317-437-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 010751
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License Number State | CT
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