| Sph Bridgeport, Llc | |
|
161 Boston Ave Bridgeport CT 06610-1662 | |
| (203) 873-0598 | |
| (203) 873-0602 |
| Full Name | Sph Bridgeport, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 161 Boston Ave, Bridgeport, Connecticut |
| Authorized Official Name and Position | Kigons Song (OWNER) |
| Authorized Official Contact | 6463696918 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sph Bridgeport, Llc 161 Boston Ave Bridgeport CT 06610-1662 Ph: (203) 873-0598 | Sph Bridgeport, Llc 161 Boston Ave Bridgeport CT 06610-1662 Ph: (203) 873-0598 |
| NPI Number | 1194193094 |
|---|---|
| Provider Enumeration Date | 09/09/2015 |
| Last Update Date | 09/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194193094 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
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