Provider Demographics
NPI:1518256643
Name:HARTFORD COSMETIC DENTAL CENTER
Entity Type:Organization
Organization Name:HARTFORD COSMETIC DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PART OWNER OF THE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:CHIA HUI
Authorized Official - Middle Name:JENNY
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-453-4055
Mailing Address - Street 1:609 FARMINGTON AVE # LL2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3081
Mailing Address - Country:US
Mailing Address - Phone:860-206-9641
Mailing Address - Fax:
Practice Address - Street 1:609 FARMINGTON AVE # LL2
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3081
Practice Address - Country:US
Practice Address - Phone:860-206-9641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101101223G0001X
CT100041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty