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
149 DURHAM RD STE 33, MADISON, CT 06443-2680
(203) 245-1454
(203) 245-8998
Mailing address
149 DURHAM RD STE 33, MADISON, CT 06443-2680
(203) 245-1454
(203) 245-8998
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
5525
CT
1223P0221X
Pediatric Dentistry
7814
CT
1223P0221X
Pediatric Dentistry
Primary
9409
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184624058
INDIVIDUAL NPI
CT
01
—
1710988704
INDIVIDUAL NPI
CT
01
—
1760569685
INDIVIDUAL NPI
CT
Enumeration date
01/24/2007
Last updated
08/22/2020
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