Organization
STAMFORD PEDIATRIC DENTISTRY, LLC
Active
Other names
Long Ridge Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAE CHUL HO DDS (OWNER)
(860) 342-4141
Entity
Organization
Contact information
Practice address
4 LONG RIDGE RD, STAMFORD, CT 06905-3802
(860) 342-4141
(860) 342-1284
Mailing address
4 LONG RIDGE RD, STAMFORD, CT 06905-3802
(860) 342-4141
(860) 342-1284
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9846
CT
1223P0221X
Pediatric Dentistry
9920
CT
261QD0000X
Dental Clinic/Center
009846
CT
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
009846
CT
Other
Enumeration date
07/19/2011
Last updated
02/17/2014
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