Connecticut Dental Gruop, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

08681 Issued in CT

Legal business name

CONNECTICUT DENTAL GRUOP, LLC

Practice address

4699 Main St
Suite 203
Bridgeport, CT 06606-1830

Phone

(203) 372-4200

Fax

(203) 372-2376

NPI assigned

Aug 24, 2009

Last updated

Aug 24, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mehran Azar, D.D.S.NPI 1851416135

Title

Member

Phone

(203) 372-4200

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mehran Azar, DDS

  • Dentist
  • Bridgeport, CT
  • NPI 1851416135
  NPD (past) Authorized official

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

{
    "created_epoch": "1251072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251072000000",
    "number": "1083847172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4699 MAIN ST",
            "address_2": "SUITE 203",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061830",
            "telephone_number": "203-372-4200",
            "fax_number": "203-372-2376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4699 MAIN ST",
            "address_2": "SUITE 203",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061830",
            "telephone_number": "203-372-4200",
            "fax_number": "203-372-2376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT DENTAL GRUOP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-24",
        "last_updated": "2009-08-24",
        "status": "A",
        "authorized_official_last_name": "AZAR",
        "authorized_official_first_name": "MEHRAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "203-372-4200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "08681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; 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.