| Family Dental Group C.a. | |
|
468 Clinton Ave Bridgeport CT 06605-1713 | |
| (203) 337-6266 | |
| (203) 337-6261 |
| Full Name | Family Dental Group C.a. |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 468 Clinton Ave, Bridgeport, Connecticut |
| Authorized Official Name and Position | Peter V Munk (DENTIST/PARTNER) |
| Authorized Official Contact | 2033376266 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Dental Group C.a. 468 Clinton Ave Bridgeport CT 06605-1713 Ph: (203) 337-6266 | Family Dental Group C.a. 468 Clinton Ave Bridgeport CT 06605-1713 Ph: (203) 337-6266 |
| NPI Number | 1700981602 |
|---|---|
| Provider Enumeration Date | 09/14/2006 |
| Last Update Date | 06/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700981602 | NPI | - | NPPES |
| 004163002 | Medicaid | CT | |
| 008008008 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 006670 (Connecticut) | Secondary |
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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