Provider Demographics
NPI:1447750997
Name:NEW HAVEN FAMILY DENTAL GROUP LLC
Entity Type:Organization
Organization Name:NEW HAVEN FAMILY DENTAL GROUP LLC
Other - Org Name:HORIZON DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BETHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-859-5239
Mailing Address - Street 1:214 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3721
Mailing Address - Country:US
Mailing Address - Phone:203-859-5239
Mailing Address - Fax:203-859-5273
Practice Address - Street 1:214 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3721
Practice Address - Country:US
Practice Address - Phone:203-859-5239
Practice Address - Fax:203-859-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty