Provider Demographics
NPI:1538331434
Name:NAZNEEN, IFFAT (DDS)
Entity Type:Individual
Prefix:DR
First Name:IFFAT
Middle Name:
Last Name:NAZNEEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3723
Mailing Address - Country:US
Mailing Address - Phone:203-691-6145
Mailing Address - Fax:203-691-5515
Practice Address - Street 1:262 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3742
Practice Address - Country:US
Practice Address - Phone:203-691-6145
Practice Address - Fax:203-691-5515
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1538331434Medicaid