Individual
OAK GAR MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
144 BOSTON AVE, BRIDGEPORT, CT 06610-1604
(475) 422-8761
Mailing address
5300 HUNTINGTON DR S APT 3, LOS ANGELES, CA 90032-1767
(626) 418-8566
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2.014402
CT
1223G0001X
General Practice Dentistry
DN10000929
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/15/2025
Last updated
07/01/2025
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