Provider Demographics
NPI:1831476050
Name:DENTAL CENTERS OF FAIRFILED COUNTY LLC
Entity Type:Organization
Organization Name:DENTAL CENTERS OF FAIRFILED COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MONTANARO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-257-9250
Mailing Address - Street 1:140 HERD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604
Mailing Address - Country:US
Mailing Address - Phone:203-371-0119
Mailing Address - Fax:203-372-3700
Practice Address - Street 1:140 HURD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-2701
Practice Address - Country:US
Practice Address - Phone:203-371-0119
Practice Address - Fax:203-372-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT45011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty