Organization
FAMILY DENTAL PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLGA GONCHAROVA DDS (OWNER)
(203) 353-8532
Entity
Organization
Contact information
Practice address
316 HOPE ST, STAMFORD, CT 06906-1704
(203) 353-8532
(203) 353-8542
Mailing address
316 HOPE ST, STAMFORD, CT 06906-1704
(203) 353-8532
(203) 353-8542
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
008984
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002089846
—
CT
Enumeration date
01/02/2009
Last updated
01/02/2009
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