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Organization

SPH ENTERPRISE LLC

Active
Other names
Bridgeport Family Dental Group
Organization subpart
No

Provider details

NPI number
Authorized official
DIANE DEVRIES (BUSINESS MANAGER)
(203) 873-0598
Entity
Organization

Contact information

Practice address
161 BOSTON AVE, BRIDGEPORT, CT 06610-1662
(203) 873-0598
Mailing address
161 BOSTON AVE, BRIDGEPORT, CT 06610-1662
(203) 873-0598

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
009785
CT
1223G0001X
General Practice Dentistry
009846
CT
1223G0001X
General Practice Dentistry
009920
CT
1223P0221X
Pediatric Dentistry
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
010946
CT

Other

Enumeration date
03/12/2010
Last updated
05/08/2014
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