| Shippan Dental Center | |
|
587 Elm St Shippan Dental Center Stamford CT 06902-5113 | |
| (203) 658-8797 | |
| (203) 355-9837 |
| Full Name | Shippan Dental Center |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 587 Elm St, Stamford, Connecticut |
| Authorized Official Name and Position | Olga Goncharova (OWNER) |
| Authorized Official Contact | 2036588797 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shippan Dental Center 316 Hope St Family Dental Practice Stamford CT 06906-1704 Ph: (203) 353-8532 | Shippan Dental Center 587 Elm St Shippan Dental Center Stamford CT 06902-5113 Ph: (203) 658-8797 |
| NPI Number | 1063758183 |
|---|---|
| Provider Enumeration Date | 12/18/2012 |
| Last Update Date | 12/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063758183 | NPI | - | NPPES |
| 002089846 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 8984 (Connecticut) | Primary |
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