Provider Demographics
NPI:1508686320
Name:CHILDRENS DENTAL HEALTH OF BRIDGEPORT PLLC
Entity type:Organization
Organization Name:CHILDRENS DENTAL HEALTH OF BRIDGEPORT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-712-0708
Mailing Address - Street 1:3715 MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3611
Mailing Address - Country:US
Mailing Address - Phone:609-712-0708
Mailing Address - Fax:
Practice Address - Street 1:3715 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3611
Practice Address - Country:US
Practice Address - Phone:609-712-0708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty