Organization
MGM FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAMED GHORBANI-MOGHADDAM DDS (OWNER)
(203) 612-6079
Entity
Organization
Contact information
Practice address
2690 E MAIN ST, BRIDGEPORT, CT 06610-1422
(203) 612-6079
(203) 612-6081
Mailing address
2690 E MAIN ST, BRIDGEPORT, CT 06610-1422
(203) 612-6079
(203) 612-6081
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
11154
CT
Other
Enumeration date
12/06/2017
Last updated
12/06/2017
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