Provider Demographics
NPI:1316180201
Name:FAMILY DENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:FAMILY DENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FROMZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-504-8318
Mailing Address - Street 1:44 STRAWBERRY HILL AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2632
Mailing Address - Country:US
Mailing Address - Phone:203-504-8318
Mailing Address - Fax:203-504-8319
Practice Address - Street 1:44 STRAWBERRY HILL AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2632
Practice Address - Country:US
Practice Address - Phone:203-504-8318
Practice Address - Fax:203-504-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0096101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty