Provider Demographics
NPI:1992939060
Name:YOLANI P. EDIRISINGHE, DMD, LLC
Entity type:Organization
Organization Name:YOLANI P. EDIRISINGHE, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANI
Authorized Official - Middle Name:P
Authorized Official - Last Name:EDIRISINGHE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-878-1766
Mailing Address - Street 1:53 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3473
Mailing Address - Country:US
Mailing Address - Phone:203-878-1766
Mailing Address - Fax:
Practice Address - Street 1:53 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3473
Practice Address - Country:US
Practice Address - Phone:203-878-1766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0091991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty