Organization
KIDS DENTAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMMAR IDLIBI (OWNER)
(860) 584-0441
Entity
Organization
Contact information
Practice address
733 TERRYVILLE AVE, BRISTOL, CT 06010-4034
(860) 584-0441
(860) 516-8918
Mailing address
733 TERRYVILLE AVE, BRISTOL, CT 06010-4034
(860) 584-0441
(860) 516-8918
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
6903
CT
1223G0001X
General Practice Dentistry
10813
CT
1223P0221X
Pediatric Dentistry
Primary
7893
CT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
008462
CT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
10740
CT
Other
Enumeration date
06/13/2007
Last updated
07/03/2013
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