MEDICARE: IFFAT NAZNEEN DDS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1275884991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IFFAT NAZNEEN DDS LLC

Provider Business Mailing Address
First Line	:	262 GRAND AVE
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06513-3723
Country	:	US
Telephone Number	:	203-691-6145
Fax Number	:	203-691-5515

Provider Business Practice Location Address
First Line	:	262 GRAND AVE
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06513-3723
Country	:	US
Telephone Number	:	203-691-6145
Fax Number	:	203-691-5515

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. IFFAT NAZNEEN
Credential	:	DDS
Telephone Number	:	203-691-6145

Provider Enumeration Date	:	09/20/2012
Last Update Date	:	10/16/2013

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