Provider Demographics
NPI:1285867796
Name:CONNECTIDENT, LLC
Entity Type:Organization
Organization Name:CONNECTIDENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOON JOONG
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-786-2187
Mailing Address - Street 1:1011 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2294
Mailing Address - Country:US
Mailing Address - Phone:860-528-3350
Mailing Address - Fax:
Practice Address - Street 1:1011 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2294
Practice Address - Country:US
Practice Address - Phone:860-528-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONNECTIDENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-31
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10110122300000X
CT100041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty