Colin Kong, D.M.D., LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

11032 Issued in CT

Legal business name

COLIN KONG, D.M.D., LLC

Doing business as

Pediatric Dentistry Associates

Practice address

991 State St
New Haven, CT 06511-3993

Phone

(203) 787-3669

NPI assigned

Dec 9, 2016

Organization subpart

No

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

Authorized official

Name

Kendra Smith

Title

Practice Administrator

Phone

(203) 787-3669

Specialties & licenses 1

Addresses

Other names 1

• Pediatric Dentistry Associates Doing business as

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

{
    "created_epoch": "1481241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482451200000",
    "number": "1265976260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 STATE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113993",
            "telephone_number": "203-787-3669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "991 STATE ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113993",
            "telephone_number": "203-787-3669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLIN KONG, D.M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-09",
        "last_updated": "2016-12-23",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "203-787-3669"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CT",
            "license": "11032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dentistry Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Colella, P.A.
• Benjamin Coleman
• Charles Mason Coleman
• Kevin Coleman
• Antonia Coletta, DENTAL HYGIENIST
• Ashleigh Colin, MBBCH
• Sheila Michelle Collado, FNP-BC
• John Lind Collar III, MD
• Emily Collier, MD
• Anna Collimore

• Dental Clinic/Center in New Haven, CT
• Providers in New Haven, CT by specialty
• Dental Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2016; 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.