Organization
PEDIATRIC DENTISTRY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS B. KECK D.M.D. (OWNER)
(203) 787-3669
Entity
Organization
Contact information
Practice address
991 STATE ST, NEW HAVEN, CT 06511-3993
(203) 787-3669
(203) 785-8416
Mailing address
991 STATE ST, NEW HAVEN, CT 06511-3993
(203) 787-3669
(203) 785-8416
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
5525
CT
1223P0221X
Pediatric Dentistry
Primary
7814
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184624058
INDIVIDUAL NPI
CT
01
—
1710988704
INDIVIDUAL NPI
CT
Enumeration date
01/23/2007
Last updated
12/12/2016
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