Provider Demographics
NPI:1356531552
Name:UNIVERSITY OF NEW HAVEN DENTAL CENTER
Entity type:Organization
Organization Name:UNIVERSITY OF NEW HAVEN DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMATO-PALUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-931-6025
Mailing Address - Street 1:419 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1918
Mailing Address - Country:US
Mailing Address - Phone:203-931-6028
Mailing Address - Fax:
Practice Address - Street 1:419 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1918
Practice Address - Country:US
Practice Address - Phone:203-931-6028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center