Organization
NOVA DENTAL NORTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASMA IJAZ DDS (OWNER)
(203) 234-3900
Entity
Organization
Contact information
Practice address
136 BERLIN RD, CROMWELL, CT 06416-2627
(860) 358-9040
(860) 358-9042
Mailing address
136 BERLIN RD, CROMWELL, CT 06416-2627
(860) 358-9040
(860) 358-9042
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9252
CT
1223P0221X
Pediatric Dentistry
9252
CT
1223P0300X
Periodontics
9252
CT
1223P0700X
Prosthodontics
9252
CT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
9252
CT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
9252
CT
Other
Enumeration date
06/12/2015
Last updated
06/12/2015
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