Provider Demographics
NPI:1558506535
Name:COMPLETE DENTAL SERVICE LLC
Entity Type:Organization
Organization Name:COMPLETE DENTAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BETROS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-720-1911
Mailing Address - Street 1:727 RUBBER AVE
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3642
Mailing Address - Country:US
Mailing Address - Phone:203-720-1911
Mailing Address - Fax:203-729-8968
Practice Address - Street 1:727 RUBBER AVE
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-3642
Practice Address - Country:US
Practice Address - Phone:203-720-1911
Practice Address - Fax:203-729-8968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002081941Medicaid