Provider Demographics
NPI:1811145857
Name:FAIRFIELD PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:FAIRFIELD PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-783-9994
Mailing Address - Street 1:209 BOSTON POST RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3161
Mailing Address - Country:US
Mailing Address - Phone:203-783-9994
Mailing Address - Fax:203-783-9961
Practice Address - Street 1:209 BOSTON POST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3161
Practice Address - Country:US
Practice Address - Phone:203-783-9994
Practice Address - Fax:203-783-9961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty