Provider Demographics
NPI:1700521416
Name:TMJ THERAPY CENTER OF CT LLC
Entity Type:Organization
Organization Name:TMJ THERAPY CENTER OF CT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACZUGA-STERN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-335-0020
Mailing Address - Street 1:1100 KINGS HWY E STE 2D
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-5400
Mailing Address - Country:US
Mailing Address - Phone:203-335-0020
Mailing Address - Fax:203-335-0030
Practice Address - Street 1:1100 KINGS HWY E STE 2D
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-5400
Practice Address - Country:US
Practice Address - Phone:203-335-0020
Practice Address - Fax:866-262-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty