Provider Demographics
NPI:1275884991
Name:IFFAT NAZNEEN DDS LLC
Entity Type:Organization
Organization Name:IFFAT NAZNEEN DDS LLC
Other - Org Name:GRAND DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IFFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZNEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-691-6145
Mailing Address - Street 1:262 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3723
Mailing Address - Country:US
Mailing Address - Phone:203-691-6145
Mailing Address - Fax:203-691-5515
Practice Address - Street 1:262 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3723
Practice Address - Country:US
Practice Address - Phone:203-691-6145
Practice Address - Fax:203-691-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty