| Pediatric Dentistry Associates, Llc | |
|
991 State St New Haven CT 06511-3993 | |
| (203) 787-3669 | |
| (203) 785-8416 |
| Full Name | Pediatric Dentistry Associates, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 991 State St, New Haven, Connecticut |
| Authorized Official Name and Position | Douglas B. Keck (OWNER) |
| Authorized Official Contact | 2037873669 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry Associates, Llc 991 State St New Haven CT 06511-3993 Ph: (203) 787-3669 | Pediatric Dentistry Associates, Llc 991 State St New Haven CT 06511-3993 Ph: (203) 787-3669 |
| NPI Number | 1740334002 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 12/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740334002 | NPI | - | NPPES |
| 1184624058 | Other | CT | INDIVIDUAL NPI |
| 1710988704 | Other | CT | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 5525 (Connecticut) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | 7814 (Connecticut) | Primary |
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