NPIMap

Organization Active NPI

Bridgeport Dentist

  • General Practice Dentistry
  • Bridgeport, CT
National Provider Identifier
1154628477
Registry record updated Feb 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
010006 Issued in CT
Legal business name
BRIDGEPORT DENTIST
Practice address
2992 Main St
Bridgeport, CT 06606-4226
Phone
(203) 873-0708
NPI assigned
Feb 23, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2011

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

Authorized official

Name
Mira Yi
Title
Director
Phone
(203) 873-0708

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 010006 CT Primary

Addresses

Primary practice location

2992 Main St
Bridgeport, CT 06606-4226

Mailing address

2992 Main St
Bridgeport, CT 06606-4226
Phone (203) 873-0708

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1298419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298419200000",
    "number": "1154628477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2992 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064226",
            "telephone_number": "203-873-0708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2992 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064226",
            "telephone_number": "203-873-0708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT DENTIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-23",
        "last_updated": "2011-02-23",
        "status": "A",
        "authorized_official_last_name": "YI",
        "authorized_official_first_name": "MIRA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "203-873-0708"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "010006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; 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.