MEDICARE: NORWALK FAMILY DENTAL, PC

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	11707	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497283022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORWALK FAMILY DENTAL, PC

Provider Business Mailing Address
First Line	:	26 CHESTNUT HILL RD
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06851-2524
Country	:	US
Telephone Number	:	203-846-3251
Fax Number	:	203-846-3870

Provider Business Practice Location Address
First Line	:	26 CHESTNUT HILL RD
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06851-2524
Country	:	US
Telephone Number	:	203-846-3251
Fax Number	:	203-846-3870

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NAZNEEN REHAN JAFFRI
Credential	:	DDS
Telephone Number	:	917-886-9048

Provider Enumeration Date	:	05/26/2017
Last Update Date	:	07/21/2022

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Directions to “NORWALK FAMILY DENTAL, PC ” Practice Location

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