Provider Demographics
NPI:1144767278
Name:UNIVERSITY OF NEW HAVEN
Entity Type:Organization
Organization Name:UNIVERSITY OF NEW HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VELOZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDH,BS
Authorized Official - Phone:203-218-5960
Mailing Address - Street 1:27 OCTOBER LN
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1649
Mailing Address - Country:US
Mailing Address - Phone:203-218-5960
Mailing Address - Fax:
Practice Address - Street 1:27 OCTOBER LN
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1649
Practice Address - Country:US
Practice Address - Phone:203-218-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006961261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental