Provider Demographics
NPI:1497283022
Name:NORWALK FAMILY DENTAL, PC
Entity Type:Organization
Organization Name:NORWALK FAMILY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZNEEN
Authorized Official - Middle Name:REHAN
Authorized Official - Last Name:JAFFRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-886-9048
Mailing Address - Street 1:26 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-2524
Mailing Address - Country:US
Mailing Address - Phone:203-846-3251
Mailing Address - Fax:203-846-3870
Practice Address - Street 1:26 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-2524
Practice Address - Country:US
Practice Address - Phone:203-846-3251
Practice Address - Fax:203-846-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11707261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008068762Medicaid