Organization
SIZ, LLC
Active
Other names
Grand Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IFFAT NAZNEEN D.D.S. (OWNER/DENTIST)
(203) 691-6145
Entity
Organization
Contact information
Practice address
1041-1043 EAST MAIN STREET, BRIDGEPORT, CT 06608-1916
(203) 691-6145
(203) 691-5515
Mailing address
1041-1043 EAST MAIN STREET, BRIDGEPORT, CT 06608-1916
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
009562
CT
Other
Enumeration date
08/29/2014
Last updated
09/16/2014
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