Divine Dentistry PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DIVINE DENTISTRY PC

Doing business as

Divine Dentistry at Fairfield

Practice address

2452 Black Rock Tpke Ste 12
Fairfield, CT 06825-2417

Phone

(203) 372-9848

NPI assigned

Feb 23, 2023

Last updated

Feb 23, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miss Alexia Kennedy

Title

Receptionist

Phone

(203) 372-9848

Specialties & licenses 1

Addresses

Other names 1

• Divine Dentistry at Fairfield Doing business as

Locations

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

{
    "created_epoch": "1677110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1427756949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2452 BLACK ROCK TPKE STE 12",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068252417",
            "telephone_number": "203-372-9848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2452 BLACK ROCK TPKE STE 12",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068252417",
            "telephone_number": "203-372-9848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-23",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "ALEXIA",
        "authorized_official_title_or_position": "RECEPTIONIST",
        "authorized_official_telephone_number": "203-372-9848",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divine Dentistry at Fairfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan John Dillon, APRN
• Marleena Dimaggio, APRN
• Discovery Practice Management, Inc (Center For Discovery, Fairfield)
• Discovery Practice Management, Inc (Discovery Mood & Anxiety Program, Fairfield)
• Discovery Practice Management, Inc. (Center For Discovery, Wellington)
• Renee Patrice Divine
• Alison Jean Djuve, SLP
• Brigette E Dmowski, ATCL
• Quynh DO
• Mary Dobson, LMFT

• General Practice Dentistry in Fairfield, CT
• Providers in Fairfield, 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 Feb 23, 2023; 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.