Provider Demographics
NPI:1578773396
Name:CONNECTICUT DENTAL CARE P.C.
Entity Type:Organization
Organization Name:CONNECTICUT DENTAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMELI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-878-8000
Mailing Address - Street 1:1201 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2703
Mailing Address - Country:US
Mailing Address - Phone:203-878-8000
Mailing Address - Fax:203-878-9000
Practice Address - Street 1:1201 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2703
Practice Address - Country:US
Practice Address - Phone:203-878-8000
Practice Address - Fax:203-878-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty