Organization
FIRST DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANG HYUN NA (OWNER)
(203) 292-5753
Entity
Organization
Contact information
Practice address
325 REEF RD STE 106, FAIRFIELD, CT 06824-6537
(203) 292-5753
Mailing address
325 REEF RD STE 106, FAIRFIELD, CT 06824-6537
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008025885
—
CT
Enumeration date
12/11/2017
Last updated
12/11/2017
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