Organization
ADVANCED DENTAL OF WALLINGFORD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN KU (OWNER)
(713) 591-5434
Entity
Organization
Contact information
Practice address
44 FAIR ST, WALLINGFORD, CT 06492-4214
(713) 591-5434
Mailing address
910 BOSTON POST RD OFC, WEST HAVEN, CT 06516-1845
(713) 591-5434
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/12/2020
Last updated
10/12/2020
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