Provider Demographics
NPI:1477230753
Name:MITRA KABAKOFF D.D.D., PLLC
Entity Type:Organization
Organization Name:MITRA KABAKOFF D.D.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KABAKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-312-4744
Mailing Address - Street 1:231 FARMINGTON AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:231 FARMINGTON AVE STE 302
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1915
Practice Address - Country:US
Practice Address - Phone:860-269-0949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty