Northeast Dental Solutions LLC

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

006295 Issued in CT

Legal business name

NORTHEAST DENTAL SOLUTIONS LLC

Practice address

56 Harriet St
First Floor
Bridgeport, CT 06608-2131

Phone

(203) 338-0090

NPI assigned

May 21, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Clive B. Rusell

Title

Part Owner/Manager

Phone

(203) 338-0090

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1274400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274400000000",
    "number": "1093034621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 HARRIET ST",
            "address_2": "FIRST FLOOR",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066082131",
            "telephone_number": "203-338-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 HARRIET ST",
            "address_2": "FIRST FLOOR",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066082131",
            "telephone_number": "203-338-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST DENTAL SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-21",
        "last_updated": "2010-05-21",
        "status": "A",
        "authorized_official_last_name": "RUSELL",
        "authorized_official_first_name": "CLIVE",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PART OWNER/MANAGER",
        "authorized_official_telephone_number": "203-338-0090",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "009777",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "CT",
            "license": "006295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Hygienist in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Dental Hygienist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; 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.