NPIMap

Organization Active NPI

Connecticut Dental Professionals, P.C.

  • General Practice Dentistry
  • Norwalk, CT
National Provider Identifier
1104387489
Registry record updated Mar 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CONNECTICUT DENTAL PROFESSIONALS, P.C.
Practice address
111 East Ave Ste 200
Norwalk, CT 06851-5014
Phone
(203) 866-8585
NPI assigned
Mar 28, 2019
Organization subpart
Yes
Parent organization
CONNECTICUT DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2019

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

Authorized official

Name
Tabatha Lemke
Title
Credentialing Coordinator
Phone
(217) 540-6078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

111 East Ave Ste 200
Norwalk, CT 06851-5014

Mailing address

111 East Ave Ste 200
Norwalk, CT 06851-5014

Other names 1

  • East Avenue Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Connecticut Dental Professionals PC9 organizations share this tax ID, including this one
Part of
Connecticut Dental Professionals PC

Other organizations with this tax ID 8

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

Locations

131 New London Tpke
Ste 211
Glastonbury, CT 06033
Phone (860) 327-4942

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1104387489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 EAST AVE STE 200",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068515014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 EAST AVE STE 200",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068515014",
            "telephone_number": "203-866-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONNECTICUT DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2019-03-28",
        "last_updated": "2019-03-28",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-6078"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Avenue Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norwalk, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; 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.