Organization
DR.DENTAL OF NEW HAVEN, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAYNE MICHAEL BOSMA (MANAGING DIRECTOR)
(203) 671-8949
Entity
Organization
Contact information
Practice address
122 AMITY ROAD, NEW HAVEN, CT 06515
(203) 671-8949
(203) 288-3004
Mailing address
122 AMITY ROAD, NEW HAVEN, CT 06515
(203) 671-8949
(203) 288-3004
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008007943
—
CT
Enumeration date
05/31/2012
Last updated
05/31/2012
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