# NOVA DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760431621
- **Authorized official:** ASMA IJAZ D.D.S. (OWNER)
- **Authorized official phone:** (203) 234-3900

## Contact information

- **Practice address:** 521 WASHINGTON AVE, NORTH HAVEN, CT 06473-1312
- **Practice address phone:** (203) 234-3900
- **Practice address fax:** (203) 234-3941
- **Mailing address:** 521 WASHINGTON AVE, NORTH HAVEN, CT 06473-1312
- **Mailing address phone:** (203) 234-3900
- **Mailing address fax:** (203) 234-3941

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 9252 | CT | — |
| 1223G0001X | General Practice Dentistry | 9252 | CT | Yes |
| 1223P0221X | Pediatric Dentistry | 10478 | CT | — |
| 1223P0700X | Prosthodontics | 9252 | CT | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 9252 | CT | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | 9252 | CT | — |

## Other

- **Enumeration date:** 05/09/2006
- **Last updated:** 03/03/2015