Provider Demographics
NPI:1942502695
Name:NORWALK FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:NORWALK FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZEEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUNASRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-299-0111
Mailing Address - Street 1:91 EAST AVE
Mailing Address - Street 2:G
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5020
Mailing Address - Country:US
Mailing Address - Phone:203-299-0111
Mailing Address - Fax:203-286-1163
Practice Address - Street 1:91 EAST AVE
Practice Address - Street 2:G
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5020
Practice Address - Country:US
Practice Address - Phone:203-299-0111
Practice Address - Fax:203-286-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty