Provider Demographics
NPI:1851534069
Name:DR. QUN ZENG DDS PC
Entity Type:Organization
Organization Name:DR. QUN ZENG DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:ZENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-569-1800
Mailing Address - Street 1:800 SILVER LN STE 238
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1233
Mailing Address - Country:US
Mailing Address - Phone:860-569-1800
Mailing Address - Fax:
Practice Address - Street 1:800 SILVER LN STE 238
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1233
Practice Address - Country:US
Practice Address - Phone:860-569-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6350122300000X
CT010422122300000X
CT94381223G0001X
CT0040641223G0001X
CT3906 CT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1659677862OtherINDIVIDUAL NPI
CT002094382Medicaid
CT1710198734OtherINDIVIDUAL NPI
CT002040640Medicaid
CT1326299934OtherINDIVIDUAL NPI