Provider Demographics
NPI:1558727131
Name:KIDS DENTAL CARE NEW BRITAIN, LLC
Entity Type:Organization
Organization Name:KIDS DENTAL CARE NEW BRITAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:IDLIBI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-584-0441
Mailing Address - Street 1:1141 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-1507
Mailing Address - Country:US
Mailing Address - Phone:860-584-0441
Mailing Address - Fax:860-516-8918
Practice Address - Street 1:1141 STANLEY ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1507
Practice Address - Country:US
Practice Address - Phone:860-584-0441
Practice Address - Fax:860-516-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7893122300000X, 1223G0001X, 1223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty