Professional Dental Alliance of CT - Ortho, PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF CT - ORTHO, PLLC

Doing business as

First Impressions Orthodontics

Practice address

1476 Post Rd
Fairfield, CT 06824-5937

Phone

(203) 292-9596

NPI assigned

Nov 18, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Erica Quinteros

Title

Credentialing

Phone

(724) 901-1964

Specialties & licenses 1

Addresses

Other names 1

• First Impressions Orthodontics Doing business as

Tax ID family

First Impressions Orthodontics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Professional Dental Alliance of CT - Ortho, PLLC

  dba First Impressions Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fairfield, CT
  • NPI 1306624143
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1053136846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 ENTERPRISE DR",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152751223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1476 POST RD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245937",
            "telephone_number": "203-292-9596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "493 Westport Ave",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CT",
            "postal_code": "068514411",
            "country_code": "US",
            "telephone_number": "475-470-0110",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "324 Elm St Ste 101B",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "CT",
            "postal_code": "064682283",
            "country_code": "US",
            "telephone_number": "203-292-9595",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF CT - ORTHO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "QUINTEROS",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "724-901-1964"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Impressions Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Primary Care Physicians of Fairfield, P.C.
• Prime Healthcare of Southport,LLC
• Primed, LLC
• Baylie Pritchard, ND
• William Vanderveer Probasco, M.D., M.S.
• Professional Dental Alliance of CT - Ortho, PLLC (First Impressions Orthodontics)
• Professional Dental Alliance of CT - Pedo, PLLC (Kids First Pediatric Dentistry & Orthodontics)
• Professional Dental Alliance of CT - Pedo, PLLC (Kids First Pediatric Dentistry & Orthodontics)
• Roseanne Prunty, PT, DPT
• Eleni Psathas, ATC

• Orthodontics and Dentofacial Orthopedics Dentistry in Fairfield, CT
• Providers in Fairfield, CT by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.