Provider Demographics
NPI:1326424995
Name:PRINCEPS HEALTHCARE
Entity Type:Organization
Organization Name:PRINCEPS HEALTHCARE
Other - Org Name:WESTVILLE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-691-5389
Mailing Address - Street 1:881 WHALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1728
Mailing Address - Country:US
Mailing Address - Phone:203-691-5389
Mailing Address - Fax:
Practice Address - Street 1:881 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1728
Practice Address - Country:US
Practice Address - Phone:203-691-5389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty