| Magicland Pediatric Dental Llc | |
|
815 Wolcott St Waterbury CT 06705-1301 | |
| (860) 282-0630 | |
| Not Available |
| Full Name | Magicland Pediatric Dental Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 815 Wolcott St, Waterbury, Connecticut |
| Authorized Official Name and Position | Chia Hui Jenny Kwon (MEMBER) |
| Authorized Official Contact | 9174534055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magicland Pediatric Dental Llc 1011 Main St East Hartford CT 06108-2294 Ph: () - | Magicland Pediatric Dental Llc 815 Wolcott St Waterbury CT 06705-1301 Ph: (860) 282-0630 |
| NPI Number | 1033622246 |
|---|---|
| Provider Enumeration Date | 11/09/2017 |
| Last Update Date | 11/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033622246 | NPI | - | NPPES |
| 008004605 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 010110 (Connecticut) | Primary |
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