| Northeast Dental Solutions Llc | |
|
56 Harriet St First Floor Bridgeport CT 06608-2131 | |
| (203) 338-0090 | |
| Not Available |
| Full Name | Northeast Dental Solutions Llc |
|---|---|
| Speciality | Dental Hygienist |
| Location | 56 Harriet St, Bridgeport, Connecticut |
| Authorized Official Name and Position | Clive B. Rusell (PART OWNER/MANAGER) |
| Authorized Official Contact | 2033380090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Dental Solutions Llc 56 Harriet St First Floor Bridgeport CT 06608-2131 Ph: (203) 338-0090 | Northeast Dental Solutions Llc 56 Harriet St First Floor Bridgeport CT 06608-2131 Ph: (203) 338-0090 |
| NPI Number | 1093034621 |
|---|---|
| Provider Enumeration Date | 05/21/2010 |
| Last Update Date | 05/21/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093034621 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 009777 (Connecticut) | Secondary |
| 124Q00000X | Dental Hygienist | 006295 (Connecticut) | Primary |
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