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General NPI Number Information
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NPI Number | 1679078026
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Entity Type | Organization
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Legal Business Name | DENTAL ONE LLC
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 71 EAST AVE STE A
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City | NORWALK
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State | CT
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Zip | 06851-4903
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Country | US
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Telephone | 203-850-2007
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Fax | 203-286-1230
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Provider Business Mailing Address
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Address Line | PO BOX 5238
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City | BROOKFIELD
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State | CT
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Zip | 06804-5238
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Country | US
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Telephone | 203-850-2007
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Fax | 203-286-1230
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHEIKH M ILYAS
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Credential | DDS
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Telephone | 203-850-2007
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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 | 009413
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License Number State | CT
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