Provider Demographics
NPI:1932239365
Name:DENTAL HYGIENE DIVISION
Entity Type:Organization
Organization Name:DENTAL HYGIENE DIVISION
Other - Org Name:CITY OF BRIDGEPORT HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:203-576-7441
Mailing Address - Street 1:752 E MAIN ST
Mailing Address - Street 2:FLOOR 3 ROOM 320
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06608-2335
Mailing Address - Country:US
Mailing Address - Phone:203-576-7441
Mailing Address - Fax:203-576-8311
Practice Address - Street 1:752 E MAIN ST
Practice Address - Street 2:FLOOR 3 ROOM 320
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06608-2335
Practice Address - Country:US
Practice Address - Phone:203-576-7441
Practice Address - Fax:203-576-8311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY O BRIDGEPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0033251K00000X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004011029Medicaid