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General NPI Number Information
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NPI Number | 1679746093
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Entity Type | Organization
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Legal Business Name | ELM FAMILY DENTAL ASSOCIATES LLC
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 233 ELM ST
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City | WEST HAVEN
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State | CT
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Zip | 06516-4635
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Country | US
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Telephone | 203-933-2223
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Fax | 203-933-2220
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Provider Business Mailing Address
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Address Line | 233 ELM ST
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City | WEST HAVEN
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State | CT
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Zip | 06516-4635
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Country | US
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Telephone | 203-933-2223
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Fax | 203-933-2220
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL A NORMAN
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Credential | D.M.D
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Telephone | 203-933-2223
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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 | 009760
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 008755
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License Number State | CT
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