Organization
MAGICLAND PEDIATRIC DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHIA HUI JENNY KWON DDS (MEMBER)
(917) 453-4055
Entity
Organization
Contact information
Practice address
1141 WOLCOTT ST, WATERBURY, CT 06705-1318
(860) 282-0630
Mailing address
1011 MAIN ST, EAST HARTFORD, CT 06108-2294
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008004605
—
CT
Enumeration date
11/09/2017
Last updated
02/26/2025
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