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General NPI Number Information
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NPI Number | 1669702999
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Entity Type | Organization
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Legal Business Name | DENTAL GROUP OF CT
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 921 WHITE PLAINS RD
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City | TRUMBULL
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State | CT
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Zip | 06611-4546
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Country | US
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Telephone | 203-261-2429
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Fax | 203-261-2369
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Provider Business Mailing Address
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Address Line | 921 WHITE PLAINS RD
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City | TRUMBULL
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State | CT
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Zip | 06611-4546
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Country | US
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Telephone | 203-261-2429
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Fax | 203-261-2369
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Authorized Official
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Title or Position | OWNER
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Name | MR. MEHRAN ZAMANI
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Credential |
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Telephone | 203-261-2429
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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 | 008810
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License Number State | CT
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