Provider Demographics
NPI:1073877197
Name:DENG, MIN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:MIN
Middle Name:
Last Name:DENG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:YALESVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2340
Mailing Address - Country:US
Mailing Address - Phone:203-774-0019
Mailing Address - Fax:203-774-0034
Practice Address - Street 1:60 CHURCH ST
Practice Address - Street 2:
Practice Address - City:YALESVILLE
Practice Address - State:CT
Practice Address - Zip Code:06492-2340
Practice Address - Country:US
Practice Address - Phone:203-774-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0109291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry