Dr.Dental of New Haven, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DR.DENTAL OF NEW HAVEN, PC

Practice address

122 Amity Road
New Haven, CT 06515

Phone

(203) 671-8949

Fax

(203) 288-3004

NPI assigned

May 31, 2012

Organization subpart

No

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

Authorized official

Name

Kayne Michael Bosma

Title

Managing Director

Phone

(203) 671-8949

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338422400000",
    "number": "1104187673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 AMITY ROAD",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "06515",
            "telephone_number": "203-671-8949",
            "fax_number": "203-288-3004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 AMITY ROAD",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "06515",
            "telephone_number": "203-671-8949",
            "fax_number": "203-288-3004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR.DENTAL OF NEW HAVEN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-31",
        "last_updated": "2012-05-31",
        "status": "A",
        "authorized_official_last_name": "BOSMA",
        "authorized_official_first_name": "KAYNE",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "203-671-8949"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008007943",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in New Haven, CT
• Providers in New Haven, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; 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.