| Family Dental Practice Pc | |
|
316 Hope St Stamford CT 06906-1704 | |
| (203) 353-8532 | |
| (203) 353-8542 |
| Full Name | Family Dental Practice Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 316 Hope St, Stamford, Connecticut |
| Authorized Official Name and Position | Olga Goncharova (OWNER) |
| Authorized Official Contact | 2033538532 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Dental Practice Pc 316 Hope St Stamford CT 06906-1704 Ph: (203) 353-8532 | Family Dental Practice Pc 316 Hope St Stamford CT 06906-1704 Ph: (203) 353-8532 |
| NPI Number | 1376789966 |
|---|---|
| Provider Enumeration Date | 01/02/2009 |
| Last Update Date | 01/02/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376789966 | NPI | - | NPPES |
| 002089846 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 008984 (Connecticut) | Primary |
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