Organization
SHIPPAN DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLGA GONCHAROVA DDS (OWNER)
(203) 658-8797
Entity
Organization
Contact information
Practice address
587 ELM ST, SHIPPAN DENTAL CENTER, STAMFORD, CT 06902-5113
(203) 658-8797
(203) 355-9837
Mailing address
316 HOPE ST, FAMILY DENTAL PRACTICE, STAMFORD, CT 06906-1704
(203) 353-8532
(203) 353-8542
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8984
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002089846
—
CT
Enumeration date
12/18/2012
Last updated
12/18/2012
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