Provider Demographics
NPI:1033322805
Name:FAMILY & ESTHETIC DENTISTRY OF HAMDEN LLC
Entity Type:Organization
Organization Name:FAMILY & ESTHETIC DENTISTRY OF HAMDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATARCANGELI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-248-0072
Mailing Address - Street 1:2559 DIXWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514
Mailing Address - Country:US
Mailing Address - Phone:203-248-0072
Mailing Address - Fax:203-407-8063
Practice Address - Street 1:2559 DIXWELL AVENUE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514
Practice Address - Country:US
Practice Address - Phone:203-248-0072
Practice Address - Fax:203-407-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63251223G0001X
CT84171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty