Provider Demographics
NPI:1740944354
Name:CHILDREN'S DENTISTRY OF WESTPORT,LLC
Entity type:Organization
Organization Name:CHILDREN'S DENTISTRY OF WESTPORT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SILVESTRO
Authorized Official - Middle Name:
Authorized Official - Last Name:IOMMAZZO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-548-3319
Mailing Address - Street 1:10 ALLEN PL
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4501
Mailing Address - Country:US
Mailing Address - Phone:914-548-3319
Mailing Address - Fax:
Practice Address - Street 1:127 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2422
Practice Address - Country:US
Practice Address - Phone:203-227-2377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty