Provider Demographics
NPI:1821489279
Name:REZA RADMAND DMD, A DENTAL CORP.
Entity Type:Organization
Organization Name:REZA RADMAND DMD, A DENTAL CORP.
Other - Org Name:ADVANCED DENTISTRY OF CONNECTICUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADMAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-375-1649
Mailing Address - Street 1:2318 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5966
Mailing Address - Country:US
Mailing Address - Phone:203-375-1649
Mailing Address - Fax:203-377-5251
Practice Address - Street 1:2318 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5966
Practice Address - Country:US
Practice Address - Phone:203-375-1649
Practice Address - Fax:203-377-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT102641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty