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General NPI Number Information
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NPI Number | 1700191590
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Entity Type | Organization
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Legal Business Name | DENTAL CENTER
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 5065 MAIN STREET #1118
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City | TRUMBULL
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State | CT
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Zip | 06611
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Country | US
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Telephone | 203-373-9099
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Fax | 203-373-9299
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Provider Business Mailing Address
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Address Line | 5065 MAIN ST #1118
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City | TRUMBULL
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State | CT
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Zip | 06611-4204
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Country | US
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Telephone | 203-373-9099
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Fax | 203-373-9299
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. YELENA TARAN
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Credential | DDS
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Telephone | 718-625-3106
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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 | 009326
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License Number State | CT
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