Connecticut Family Dental, Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

008314 Issued in CT

Legal business name

CONNECTICUT FAMILY DENTAL, INC

Practice address

3885 Main St
Suite 101
Bridgeport, CT 06606-2814

Phone

(203) 663-2772

Fax

(203) 275-8595

NPI assigned

Aug 6, 2010

Last updated

May 9, 2013By 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

Mr. Jackson Mendes

Title

Vice-President

Phone

(203) 663-2772

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deokjun Choi

  • Dentist
  • Bridgeport, CT
  • NPI 1306416250
  NPD (past)
• Oliver Sun

  • General Practice Dentistry
  • Lyndhurst, OH
  • NPI 1407239379
  NPD (past)

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

{
    "created_epoch": "1281052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368057600000",
    "number": "1750696399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3885 MAIN ST",
            "address_2": "SUITE 101",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066062814",
            "telephone_number": "203-663-2772",
            "fax_number": "203-275-8595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3885 MAIN ST",
            "address_2": "SUITE 101",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066062814",
            "telephone_number": "203-663-2772",
            "fax_number": "203-275-8595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT FAMILY DENTAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-06",
        "last_updated": "2013-05-09",
        "status": "A",
        "authorized_official_last_name": "MENDES",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "203-663-2772",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "008314",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CT",
            "license": "10567",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connecticut CVS Pharmacy, L.L.C. (CVS Pharmacy #01153)
• Connecticut CVS Pharmacy, L.L.C. (CVS Pharmacy # 02143)
• Connecticut CVS Pharmacy, L.L.C. (CVS Pharmacy # 11611)
• Connecticut Dental Gruop, LLC
• Connecticut Executive Caregivers LLC
• Connecticut Heart & Vascular Center, PC
• Connecticut Medical Specialists PC
• Connecticut Neurosurgical Specialists, P.C.
• Connecticut Physical Therapy
• Connecticut Renaissance, Inc.

• General Practice Dentistry in Bridgeport, CT
• Providers in Bridgeport, 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 May 9, 2013; 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.