Provider Demographics
NPI:1508993817
Name:COSMETIC AND RECONSTRUCTIVE DENTISTRY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:COSMETIC AND RECONSTRUCTIVE DENTISTRY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:GUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-255-6878
Mailing Address - Street 1:1275 POST RD
Mailing Address - Street 2:SUIT 201
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6015
Mailing Address - Country:US
Mailing Address - Phone:203-255-6878
Mailing Address - Fax:203-319-1124
Practice Address - Street 1:1275 POST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6015
Practice Address - Country:US
Practice Address - Phone:203-255-6878
Practice Address - Fax:203-319-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT43891223G0001X
CT50101223G0001X
CT84471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty