SPH BRIDGEPORT, LLC (NPI# 1194193094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194193094 |
| Entity Type | Organization |
| Organization Name | SPH BRIDGEPORT, LLC |
| Practice Address |
161 Boston Ave Bridgeport CT 06610-1662 |
| Practice Telephone | 2038730598 |
| Practice Fax Number | 2038730602 |
| Mailing Telephone | 2038730598 |
| Mailing Fax Number | 2038730602 |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |
| Authorized Official Name | DR. KIGONS SONG (OWNER) |
| Authorized Official Telephone | 6463696918 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers | ||
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Street Address |
161 BOSTON AVE |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06610-1662 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609199074 | Sph Enterprise LLC | Dentist | 161 Boston Ave, Bridgeport, CT 06610-1662 | 2010-03-12 |
| 1629564729 | Carly Krisavage | Physician Assistant | 161 Boston Ave, Bridgeport, CT 06610-1662 | 2018-07-02 |
| 1487087250 | Quentin Medical Group, LLC | Clinic/Center | 161 Boston Ave, Bridgeport, CT 06610-1662 | 2013-08-16 |
| 1437432671 | Heungjoo Sung | Dentist | 161 Boston Ave, Bridgeport, CT 06610-1662 | 2011-09-23 |
| 1619268745 | Waseem Shahid | Family Medicine | 161 Boston Ave, Bridgeport, CT 06610-1662 | 2011-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215553698 | Juan G Farfan | Nurse Anesthetist, Certified Registered | 267 Grant Sreet, Bridgeport, CT 06610 | 2020-06-22 |
| 1104446145 | Deepak Rajkumar Vangipuram | Student in an Organized Health Care Education/Training Program | Department of Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610 | 2020-04-20 |
| 1275152886 | Soniya Abraham | Student in an Organized Health Care Education/Training Program | Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610 | 2020-04-14 |
| 1538621834 | Yu Mi Kang | Student in an Organized Health Care Education/Training Program | 267 Grant Street, Yale New Haven Health/bridgeport Hosp, Bridgeport, CT 06610 | 2019-04-04 |
| 1073075024 | Ashwin Pramod Deshmukh | Student in an Organized Health Care Education/Training Program | Yale New Haven Health / Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610 | 2019-04-01 |
| 1790246866 | Prachi Mangesh Pednekar | Student in an Organized Health Care Education/Training Program | Yale New Haven Health/bridgeport Hospital, 261 Grant Street Department of Internal Medicine, Bridgeport, CT 06610 | 2019-03-29 |
| 1194247916 | Jessica M. Maddern | Social Worker | 1558 Barnum Avenue, Building C, Bridgeport, CT 06610 | 2017-07-13 |
| 1922532746 | Megha Kureti | Student in an Organized Health Care Education/Training Program | 267 Grant St Fl 3, Bridgeport, CT 06610 | 2017-04-18 |
| 1831623099 | Cynthia Joseph Walters | Nurse Anesthetist, Certified Registered | Bridgeport Hospital-anesthesia Department, 267 Grant Street, Bridgeport, CT 06610 | 2017-04-14 |
| 1285186148 | Helen Leahy | Nurse Practitioner | 439 Mill Hill Ave., Bridgeport, CT 06610 | 2016-10-26 |
| Find all providers in zip 06610 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891355814 | Kristopher Antonio Yen | Dentist | 32 Kathryn Dr, Bridgeport, CT 06610-1264 | 2019-06-20 |
| 1407239379 | Oliver Sun | Dentist | 3885 Main St Ste 101, Bridgeport, CT 06606-2814 | 2015-07-09 |
| 1679970172 | Aarti Jawa | Dentist | 594 Pequonnoack Street, Bridgeport, CT 06604 | 2014-11-26 |
| 1588064349 | Siz, LLC | Dentist | 1041-1043 East Main Street, Bridgeport, CT 06608-1916 | 2014-08-29 |
| 1306269758 | Dr.dental of Bridgeport PC | Dentist | 1700 Park Ave., Bridgeport, CT 06604-3826 | 2014-01-21 |
| 1700144714 | Hamed Ghorbani-moghaddam | Dentist | 2690 E Main St, Columbia Dental, Bridgeport, CT 06610-1422 | 2012-04-26 |
| 1831476050 | Dental Centers of Fairfiled County LLC | Dentist | 140 Hurd Ave, Bridgeport, CT 06604-2701 | 2011-11-16 |
| 1124308184 | Family Dentistry of Bridgeport P.C. | Dentist | 90 Brooklawn Ave, Bridgeport, CT 06604-2010 | 2011-08-23 |
| 1861789034 | Bridgeport Dental Care, LLC | Dentist | 2417 E Main St, Bridgeport, CT 06610-1802 | 2011-07-07 |
| 1154628477 | Bridgeport Dentist | Dentist | 2992 Main St, Bridgeport, CT 06606-4226 | 2011-02-23 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 06610 |
Please comment or provide details below to improve the information on SPH BRIDGEPORT, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.