| NPI | 1609199074 |
|---|---|
| Doing Business As | BRIDGEPORT FAMILY DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | DIANE DEVRIES Business Manager 203-873-0598 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CT 009785) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 009846) |
| 1223G0001X Dentist General Practice (Licence: CT 009920) | |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CT 010946) | |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2014-05-08 |