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General NPI Number Information
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NPI Number | 1841389392
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Entity Type | Individual
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Provider Name | JENNY TEKLA FEDERMAN DMD
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 60 OLD NEW MILFORD RD STE 1D
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City | BROOKFIELD
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State | CT
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Zip | 06804-2430
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Country | US
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Telephone | 203-740-8460
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Fax |
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Provider Business Mailing Address
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Address Line | 60 OLD NEW MILFORD ROAD STE 1D
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City | BROOKFIELD
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State | CT
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Zip | 06776
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Country | US
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Telephone | 203-740-8460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CT00821
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License Number State | CT
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