Organization
PARK STREET FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISHNAPRASANTH MUDUSU DMD (OWNER)
(860) 944-2802
Entity
Organization
Contact information
Practice address
454 PARK ST, HARTFORD, CT 06106-1525
(860) 944-2802
Mailing address
454 PARK ST, HARTFORD, CT 06106-1525
(860) 944-2802
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
010554
CT
Other
Enumeration date
11/28/2011
Last updated
11/28/2011
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