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FAMILY DENTAL GROUP C.A. NPI 1700981602


NPI Information

NPI: 1700981602
Provider Name: FAMILY DENTAL GROUP C.A.
Classification: Dentist - 1223P0300X
Entity Type: Organization

Specialization: Periodontics

Address:
468 CLINTON AVE
BRIDGEPORT, CT
ZIP 06605
Phone: (203) 337-6266
Get Directions

FAMILY DENTAL GROUP C.A. is a periodontics dentist in Bridgeport, CT. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. FAMILY DENTAL GROUP C.A. NPI is 1700981602. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

468 CLINTON AVE
BRIDGEPORT, CT
ZIP 06605-713
Phone: (203) 337-6266
Fax: (203) 337-6261

The provider's authorized official is Peter V Munk .
The authorized official title is Dentist/partner and has the following contact phone number (203) 337-6266.

The enumeration date for this NPI number is 9/14/2006 and was last updated on 6/12/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral Practice006670CONNECTICUTNo
21223P0300XDentistPeriodonticsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1008008008MEDICAIDCONNECTICUT
2004163002MEDICAIDCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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