MEDICARE: NEW ENGLAND DENTAL

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	1223E0200X	Endodontics	009473	CT
2	1223G0001X	General Practice Dentistry	009413	CT

General Provider Information

NPI Number	:	1295993269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW ENGLAND DENTAL

Provider Business Mailing Address
First Line	:	54 MAIN ST # F
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-3009
Country	:	US
Telephone Number	:	203-790-0111
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 MAIN ST # F
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-3009
Country	:	US
Telephone Number	:	203-790-0111
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SHEIKH M ILYAS
Credential	:	DDS
Telephone Number	:	203-790-0111

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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Directions to “NEW ENGLAND DENTAL ” Practice Location

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