NPIMap

Organization Active NPI

Connecticut Dental Professionals, P.C.

  • General Practice Dentistry
  • Milford, CT
National Provider Identifier
1104436633
Registry record updated Aug 10, 2020
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
203 Cherry St
Milford, CT 06460-3501
Phone
(203) 874-0000
NPI assigned
Aug 10, 2020
Organization subpart
Yes
Parent organization
CONNECTICUT DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 10, 2020

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

203 Cherry St
Milford, CT 06460-3501

Mailing address

203 Cherry St
Milford, CT 06460-3501
Phone (203) 874-0000

Other names 1

  • Coastal Dental Care of Milford 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.

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": "1597017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597017600000",
    "number": "1104436633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 CHERRY ST",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603501",
            "telephone_number": "203-874-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 CHERRY ST",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064603501",
            "telephone_number": "203-874-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONNECTICUT DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2020-08-10",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "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": "Coastal Dental Care of Milford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; 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.