Organization
NOVA DENTAL EAST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASMA IJAZ D.D.S. (OWNER)
(203) 626-5745
Entity
Organization
Contact information
Practice address
1241 S BROAD ST, WALLINGFORD, CT 06492-1737
(203) 626-5745
(203) 626-9213
Mailing address
1241 S BROAD ST, WALLINGFORD, CT 06492-1737
(203) 626-5745
(203) 626-9213
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9252
CT
1223G0001X
General Practice Dentistry
Primary
9252
CT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
9252
CT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
9252
CT
Other
Enumeration date
12/11/2012
Last updated
05/07/2015
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