Provider Demographics
NPI:1568861409
Name:SELLAPPAN, MEENACHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEENACHI
Middle Name:
Last Name:SELLAPPAN
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 1:160 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5715
Mailing Address - Country:US
Mailing Address - Phone:203-866-9254
Mailing Address - Fax:
Practice Address - Street 1:160 EAST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5715
Practice Address - Country:US
Practice Address - Phone:203-866-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-16
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT112691223G0001X
OH30-024159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist