Park Street Family Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

010554 Issued in CT

Legal business name

PARK STREET FAMILY DENTAL

Practice address

454 Park St
Hartford, CT 06106-1525

Phone

(860) 944-2802

NPI assigned

Nov 28, 2011

Organization subpart

No

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

Authorized official

Name

Krishnaprasanth Mudusu, DMD

Title

Owner

Phone

(860) 944-2802

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1518234079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 PARK ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061525",
            "telephone_number": "860-944-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 PARK ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061525",
            "telephone_number": "860-944-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK STREET FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-28",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "MUDUSU",
        "authorized_official_first_name": "KRISHNAPRASANTH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-944-2802",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "010554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sachin R Parekh, M.D.
• Marc Edward Parent, LADC
• Raj D. Parikh, M.D., M.P.H.
• Ronald Harry Pariser, M.D.
• Valerie Jean Parizo, LPN
• David H Park, MD
• Jennifer McNamara Park, MD
• Ann L Parke, MD
• James Parker, MD
• Janel J Parker, LCSW

• General Practice Dentistry in Hartford, CT
• Providers in Hartford, 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 Nov 28, 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.