Nova Dental North LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9252 Issued in CT

Legal business name

NOVA DENTAL NORTH LLC

Practice address

136 Berlin Rd
Cromwell, CT 06416-2627

Phone

(860) 358-9040

Fax

(860) 358-9042

NPI assigned

Jun 12, 2015

Last updated

Jun 12, 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

Asma Ijaz, DDS

Title

Owner

Phone

(203) 234-3900

Specialties & licenses 6

Addresses

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

{
    "created_epoch": "1434067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434067200000",
    "number": "1982085270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 BERLIN RD",
            "city": "CROMWELL",
            "state": "CT",
            "postal_code": "064162627",
            "telephone_number": "860-358-9040",
            "fax_number": "860-358-9042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 BERLIN RD",
            "city": "CROMWELL",
            "state": "CT",
            "postal_code": "064162627",
            "telephone_number": "860-358-9040",
            "fax_number": "860-358-9042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA DENTAL NORTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-12",
        "last_updated": "2015-06-12",
        "status": "A",
        "authorized_official_last_name": "IJAZ",
        "authorized_official_first_name": "ASMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-234-3900",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "9252",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "9252",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CT",
            "license": "9252",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "CT",
            "license": "9252",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "9252",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CT",
            "license": "9252",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Cromwell, CT
• Providers in Cromwell, 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 Jun 12, 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.