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General NPI Number Information
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NPI Number | 1861895526
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Entity Type | Organization
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Legal Business Name | DENT PLUS FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 99 PROSPECT ST UNIT 1C
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City | STAMFORD
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State | CT
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Zip | 06901-1636
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Country | US
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Telephone | 203-504-2787
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Fax |
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Provider Business Mailing Address
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Address Line | 99 PROSPECT ST UNIT 1C
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City | STAMFORD
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State | CT
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Zip | 06901-1636
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Country | US
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Telephone | 203-504-2786
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. IVAN MAKAR
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Credential |
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Telephone | 203-504-2786
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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 | 11204
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License Number State | CT
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