Judy Chou, DDS
Individual provider Active NPI Pediatric Dentistry · Gales Ferry, CT
NPI 1447740261 · NPPES record last updated Jul 20, 2020
Key facts
- NPI
- 1447740261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 12834 (CT)
- Practice address
- 1527 Route 12
Gales Ferry, CT 06335-1800 - Phone
- (860) 464-7204
- NPI assigned
- May 16, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180828001023 | CT | Order and Referring Only - Dentist |
3274882022 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12834 | CT | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Randall D Harris DDS PC | Pediatric Dentistry | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry |
1223P0221X | 12834 | CT | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
1527 Route 12
Gales Ferry, CT 06335-1800
Mailing address
PO Box 396
Gales Ferry, CT 06335-0396
Phone (860) 464-7204
Other providers in Gales Ferry, CT
- John P Ancona
- Asianoutlook in Home Care Inc.
- Abbey Baldarelli
- Robert Charles Barnett
- Christie Montgomery Therapy LLC
- Coastal Mind & Wellness Group PLLC
- Connecticut CVS Pharmacy LLC
- Lindsay J D'Amato
- Karen L Daly
All providers in Gales Ferry, CT · Pediatric Dentistry in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.