Provider Demographics
NPI:1477998086
Name:HAMDEN DENTAL CARE
Entity Type:Organization
Organization Name:HAMDEN DENTAL CARE
Other - Org Name:CONNECT FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA MOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANISH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-738-6808
Mailing Address - Street 1:50 HOLY FAMILY RD
Mailing Address - Street 2:APT 205
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2846
Mailing Address - Country:US
Mailing Address - Phone:603-738-6808
Mailing Address - Fax:413-322-3113
Practice Address - Street 1:953 DIXWELL AVE
Practice Address - Street 2:BUILDING C FIRST FLOOR
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-4951
Practice Address - Country:US
Practice Address - Phone:603-738-6808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT102011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty