NPIMap

Organization Active NPI

Nova Dental East LLC

  • General Practice Dentistry
  • Wallingford, CT
National Provider Identifier
1629313077
Registry record updated May 7, 2015
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9252 Issued in CT
Legal business name
NOVA DENTAL EAST LLC
Practice address
1241 S Broad St
Wallingford, CT 06492-1737
Phone
(203) 626-5745
Fax
(203) 626-9213
NPI assigned
Dec 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2015

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

Authorized official

Name
Asma Ijaz, D.D.S.
Title
Owner
Phone
(203) 626-5745

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 9252 CT
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 9252 CT Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 9252 CT
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 9252 CT

Addresses

Primary practice location

1241 S Broad St
Wallingford, CT 06492-1737

Mailing address

1241 S Broad St
Wallingford, CT 06492-1737
Phone (203) 626-5745

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430956800000",
    "number": "1629313077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 S BROAD ST",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064921737",
            "telephone_number": "203-626-5745",
            "fax_number": "203-626-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 S BROAD ST",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064921737",
            "telephone_number": "203-626-5745",
            "fax_number": "203-626-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA DENTAL EAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-11",
        "last_updated": "2015-05-07",
        "status": "A",
        "authorized_official_last_name": "IJAZ",
        "authorized_official_first_name": "ASMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-626-5745",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "9252",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "9252",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "9252",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CT",
            "license": "9252",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.