Provider Demographics
NPI:1710237573
Name:CONNECTICUT POST MALL DENTAL, PC
Entity Type:Organization
Organization Name:CONNECTICUT POST MALL DENTAL, PC
Other - Org Name:CONNECTICUT POST DENTAL, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKMANOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-205-0333
Mailing Address - Street 1:2 GLEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4906
Mailing Address - Country:US
Mailing Address - Phone:203-205-0333
Mailing Address - Fax:
Practice Address - Street 1:2650 OCEAN PKWY
Practice Address - Street 2:APT#4F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7759
Practice Address - Country:US
Practice Address - Phone:203-205-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty