NPIMap

Organization Active NPI

Charter Oak Dental Center LLC

  • Dentist
  • Hartford, CT
National Provider Identifier
1548635899
Registry record updated Dec 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
11063 Issued in CT
Legal business name
CHARTER OAK DENTAL CENTER LLC
Practice address
330 Main St
Hartford, CT 06106-1860
Phone
(860) 899-2804
Fax
(860) 899-2803
NPI assigned
Dec 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2015

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

Authorized official

Name
Dr. Shakil U Syed, DDS
Title
Owner/Member
Phone
(860) 899-2804

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 11063 CT Primary

Addresses

Primary practice location

330 Main St
Hartford, CT 06106-1860

Mailing address

330 Main St
Hartford, CT 06106-1860
Phone (860) 899-2804

Other identifiers 1

IdentifierTypeStateIssuer
11063OtherCTCONNECTICUT DENTAL LICENSE NUMBER

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449705600000",
    "number": "1548635899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 MAIN ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061860",
            "telephone_number": "860-899-2804",
            "fax_number": "860-899-2803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MAIN ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061860",
            "telephone_number": "860-899-2804",
            "fax_number": "860-899-2803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARTER OAK DENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-10",
        "last_updated": "2015-12-10",
        "status": "A",
        "authorized_official_last_name": "SYED",
        "authorized_official_first_name": "SHAKIL",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "860-899-2804",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "11063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICUT DENTAL LICENSE NUMBER",
            "identifier": "11063",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; 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.