MEDICARE: HAVEN DENTAL CARE PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1336983485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN DENTAL CARE PLLC

Provider Business Mailing Address
First Line	:	35 HIGH ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2315
Country	:	US
Telephone Number	:	646-712-1594
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 HIGH ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2315
Country	:	US
Telephone Number	:	646-712-1594
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. KENAN EMAD TAWEEL
Credential	:	DMD
Telephone Number	:	646-712-1594

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	07/08/2024

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