Provider Demographics
NPI:1790116036
Name:JUST4KIDZDENTISTRY
Entity Type:Organization
Organization Name:JUST4KIDZDENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:WEGRZYN
Authorized Official - Last Name:RELIGA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-426-1470
Mailing Address - Street 1:1115 WEST ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1023
Mailing Address - Country:US
Mailing Address - Phone:860-426-1470
Mailing Address - Fax:
Practice Address - Street 1:1115 WEST ST
Practice Address - Street 2:SUITE #4
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1023
Practice Address - Country:US
Practice Address - Phone:860-426-1470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0084921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty