Provider Demographics
NPI:1184057192
Name:HAMDEN FAMILY DENTAL CENTER
Entity type:Organization
Organization Name:HAMDEN FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-248-4080
Mailing Address - Street 1:4193 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1212
Mailing Address - Country:US
Mailing Address - Phone:203-248-4080
Mailing Address - Fax:203-248-4743
Practice Address - Street 1:4193 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-1212
Practice Address - Country:US
Practice Address - Phone:203-248-4080
Practice Address - Fax:203-248-4743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty