Crystal Clear Family Dentistry of CT

Primary specialty

DentistTaxonomy code 122300000X

License

010370 Issued in CT

Legal business name

CRYSTAL CLEAR FAMILY DENTISTRY OF CT

Practice address

330 Main St
Hartford, CT 06106-1860

Phone

(860) 899-2804

NPI assigned

Jun 11, 2015

Last updated

Jun 11, 2015By 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

Sarah Mekonnen, DDS

Title

Owner

Phone

(860) 899-2804

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1932580347",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CLEAR FAMILY DENTISTRY OF CT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-11",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "MEKONNEN",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-899-2804",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "010370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Herminia Cruz-Resto, MSW, LCSW
• Annette Cruz, DOULA
• Frangie Cruz, B.A.
• Marisa Alves Cruz, BS
• Zuleika Ivette Cruz
• CT Childrens Medical Center/Betances
• CT Childrens Medical Center/Betances
• CT Optimal Wellness, LLC
• CT Psychological Consulting Services, LLC
• CT.Gastroenterology Assoc. PC

• Dentist in Hartford, CT
• Providers in Hartford, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.