Provider Demographics
NPI:1679078026
Name:DENTAL ONE LLC
Entity Type:Organization
Organization Name:DENTAL ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEIKH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ILYAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-850-2007
Mailing Address - Street 1:PO BOX 5238
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-5238
Mailing Address - Country:US
Mailing Address - Phone:203-850-2007
Mailing Address - Fax:203-286-1230
Practice Address - Street 1:71 EAST AVE STE A
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4903
Practice Address - Country:US
Practice Address - Phone:203-850-2007
Practice Address - Fax:203-286-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0094131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty