Provider Demographics
NPI:1457793291
Name:MGDA
Entity Type:Organization
Organization Name:MGDA
Other - Org Name:ALBANO & GREENWALD FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-755-7748
Mailing Address - Street 1:146 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2761
Mailing Address - Country:US
Mailing Address - Phone:203-755-7748
Mailing Address - Fax:203-755-7784
Practice Address - Street 1:146 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2761
Practice Address - Country:US
Practice Address - Phone:203-755-7748
Practice Address - Fax:203-755-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007481305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization