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General NPI Number Information
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NPI Number | 1871985945
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Entity Type | Organization
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Legal Business Name | DR. DENTAL OF EAST HAVEN, PC
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 713 FOXON RD
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City | EAST HAVEN
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State | CT
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Zip | 06513-1873
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Country | US
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Telephone | 617-823-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 55 MERIDIAN ST
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City | EAST BOSTON
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State | MA
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Zip | 02128-1959
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Country | US
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Telephone | 617-567-1300
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. ALEX FAIGEL
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Credential |
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Telephone | 617-823-2111
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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 |
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License Number State |
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