| Connecticut Dental Gruop, Llc | |
|
4699 Main St Suite 203 Bridgeport CT 06606-1830 | |
| (203) 372-4200 | |
| (203) 372-2376 |
| Full Name | Connecticut Dental Gruop, Llc |
|---|---|
| Speciality | Dentist |
| Location | 4699 Main St, Bridgeport, Connecticut |
| Authorized Official Name and Position | Mehran Azar (MEMBER) |
| Authorized Official Contact | 2033724200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Connecticut Dental Gruop, Llc 4699 Main St Suite 203 Bridgeport CT 06606-1830 Ph: (203) 372-4200 | Connecticut Dental Gruop, Llc 4699 Main St Suite 203 Bridgeport CT 06606-1830 Ph: (203) 372-4200 |
| NPI Number | 1083847172 |
|---|---|
| Provider Enumeration Date | 08/24/2009 |
| Last Update Date | 08/24/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083847172 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 08681 (Connecticut) | Primary |
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