| Mozaic Senior Life | |
|
4200 Park Ave Bridgeport CT 06604 | |
| (203) 396-1075 | |
| (203) 396-1108 |
| Full Name | Mozaic Senior Life |
|---|---|
| Speciality | Dentist |
| Location | 4200 Park Ave, Bridgeport, Connecticut |
| Authorized Official Name and Position | Sheila Robinson (AR SUPERVISOR) |
| Authorized Official Contact | 2033961075 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mozaic Senior Life 4200 Park Ave Bridgeport CT 06604-1049 Ph: (203) 396-1075 | Mozaic Senior Life 4200 Park Ave Bridgeport CT 06604 Ph: (203) 396-1075 |
| NPI Number | 1710191366 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 08/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710191366 | NPI | - | NPPES |
| 004197051 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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