NPIMap

Organization Active NPI

MGM Family Dental

  • Dental Clinic/Center
  • Bridgeport, CT
National Provider Identifier
1821503210
Registry record updated Dec 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
11154 Issued in CT
Legal business name
MGM FAMILY DENTAL
Practice address
2690 E Main St
Bridgeport, CT 06610-1422
Phone
(203) 612-6079
Fax
(203) 612-6081
NPI assigned
Dec 6, 2017
Last updated
Dec 6, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2017

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

Authorized official

Name
Dr. Hamed Ghorbani-Moghaddam, DDSNPI 1700144714
Title
Owner
Phone
(203) 612-6079

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 11154 CT Primary

Addresses

Primary practice location

2690 E Main St
Bridgeport, CT 06610-1422

Mailing address

2690 E Main St
Bridgeport, CT 06610-1422
Phone (203) 612-6079

National Provider Directory

National Provider Directory

Locations

2690 E Main St
Bridgeport, CT 06610
Phone (203) 612-6079

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512518400000",
    "number": "1821503210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 E MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066101422",
            "telephone_number": "203-612-6079",
            "fax_number": "203-612-6081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2690 E MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066101422",
            "telephone_number": "203-612-6079",
            "fax_number": "203-612-6081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MGM FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-06",
        "last_updated": "2017-12-06",
        "status": "A",
        "authorized_official_last_name": "GHORBANI-MOGHADDAM",
        "authorized_official_first_name": "HAMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-612-6079",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CT",
            "license": "11154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; 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.