Provider Demographics
NPI:1770935710
Name:TEE-PEE DENTISTRY P.C.
Entity type:Organization
Organization Name:TEE-PEE DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:POWE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-909-2101
Mailing Address - Street 1:468 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1713
Mailing Address - Country:US
Mailing Address - Phone:203-337-6266
Mailing Address - Fax:203-337-6261
Practice Address - Street 1:468 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1713
Practice Address - Country:US
Practice Address - Phone:203-337-6266
Practice Address - Fax:203-337-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT107791223D0004X
CT0107791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010779OtherSTATE LICENSE
CT008041327Medicaid