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General NPI Number Information
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NPI Number | 1730736216
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Entity Type | Organization
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Legal Business Name | PEARL DENTAL OF TRUMBULL, PLLC
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 140 MONROE TPKE UNIT C
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City | TRUMBULL
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State | CT
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Zip | 06611-1357
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Country | US
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Telephone | 203-372-3626
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Fax | 203-880-5182
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Provider Business Mailing Address
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Address Line | 140 MONROE TPKE UNIT C
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City | TRUMBULL
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State | CT
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Zip | 06611-1357
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Country | US
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Telephone | 203-372-3626
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Fax | 203-880-5182
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Authorized Official
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Title or Position | OWNER
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Name | KAVEETA CHANNAMSETTY
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Credential | DDS
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Telephone | 203-372-3626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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