Provider Demographics
NPI:1225249063
Name:EASTERN CONNECTICUT DENTAL
Entity Type:Organization
Organization Name:EASTERN CONNECTICUT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMELI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-889-3638
Mailing Address - Street 1:110 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2736
Mailing Address - Country:US
Mailing Address - Phone:860-889-3638
Mailing Address - Fax:860-204-9571
Practice Address - Street 1:110 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2736
Practice Address - Country:US
Practice Address - Phone:860-889-3638
Practice Address - Fax:860-204-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty