Provider Demographics
NPI:1700191590
Name:DENTAL CENTER
Entity Type:Organization
Organization Name:DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-625-3106
Mailing Address - Street 1:5065 MAIN ST
Mailing Address - Street 2:#1118
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4204
Mailing Address - Country:US
Mailing Address - Phone:203-373-9099
Mailing Address - Fax:203-373-9299
Practice Address - Street 1:5065 MAIN STREET
Practice Address - Street 2:#1118
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611
Practice Address - Country:US
Practice Address - Phone:203-373-9099
Practice Address - Fax:203-373-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty