MODERN FAMILY DENTAL (NPI# 1386035707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386035707 |
| Entity Type | Organization |
| Organization Name | MODERN FAMILY DENTAL |
| Other Organization Name | SGROUP LLC |
| Practice Address |
360 Boston Ave Suite 17 Stratford CT 06614-5213 |
| Mailing Address |
320 Boston Ave Suite 17 Stratford CT 06614-5213 |
| Practice Telephone | 8604373462 |
| Practice Fax Number | 8604373485 |
| Mailing Telephone | 8604373462 |
| Mailing Fax Number | 8604373485 |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2015-09-21 |
| Authorized Official Name | MRS. LINDA MROWKA (OFFICE MANAGER) |
| Authorized Official Telephone | 8604373462 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
CT | Dental Providers | |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
CT | Dental Providers | |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 1386035707 | 05 | |
| CT | 1942579768 | 05 |
| Other Name | Type Code |
|---|---|
| SGroup LLC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922404185 | Modern Family Dental | Dentist | 1131 S 19th St, Philadelphia, PA 19146-2936 | 2014-11-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | MODERN FAMILY DENTAL, P.C. | 13329 Se Misty Dr Suite B, Happy Valley, OR 97086 |
| New York State Corporations | MODERN FAMILY DENTAL, PLLC | Jeffrey P Dick, Dds, 3 West Avenue, Hilton, Ny 14468 |
| Street Address |
360 BOSTON AVE SUITE 17 |
| City | STRATFORD |
| State | CT |
| Zip Code | 06614-5213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588139604 | David A Crosby | Physician Assistant | 125 Pumpkin Ground Road, Stratford, CT 06614 | 2018-10-04 |
| 1710489232 | Karen Marie Laconte | Naturopath | 720 Hilltop Dr, Stratford, CT 06614 | 2018-02-28 |
| 1972024693 | Amanda Wilson | Social Worker | 60 Edmund Street, Stratford, CT 06614 | 2017-07-03 |
| 1558801423 | Kristine Lynn Conlan | Physical Therapist | 55 Pasadena Ave., Stratford, CT 06614 | 2017-02-27 |
| 1811440258 | Seokwon Kwon | Dentist | 320 Boston Ave, Stratford, CT 06614 | 2016-08-02 |
| 1093176141 | Kathleen G Domek | Technician/Technologist | 150 Barnum Avenue Cut Off, Stratford, CT 06614 | 2016-03-17 |
| 1417328634 | Kelley Machado | Social Worker | 2127 Nichols Ave, Stratford, CT 06614 | 2015-10-14 |
| 1043629553 | Jennifer Woods-mesquita | Social Worker | 125 Greenlawn Ave, Stratford, CT 06614 | 2014-08-08 |
| 1437564010 | Jose R. Pacheco | Obstetrics & Gynecology | 120 Brightwood Ave, Stratford, CT 06614 | 2014-06-23 |
| 1740612829 | Stanley Brovender | General Practice | 773b Pontiac Lane, Stratford, CT 06614 | 2013-07-31 |
| Find all providers in zip 06614 | ||||
| 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 |
|---|---|---|---|---|
| 1912461526 | A-smile LLC | Dentist | 937 Stratford Ave Ste 1, Stratford, CT 06615-6354 | 2019-01-28 |
| 1437344249 | Ariadni Karga | Dentist | 937 Stratford Ave, Suite 1, Stratford, CT 06615-6354 | 2007-09-14 |
| 1669674115 | Mark Lee Zamat | Dentist | 1200 Linden Ave, Stratford, CT 06615-5835 | 2007-06-05 |
| 1770615254 | Neil A Goodkind | Dentist | 3638 Main St, Stratford, CT 06614-4195 | 2007-03-11 |
| 1407918105 | Edward J. Balling | Dentist | 62 Warwick Rd, Stratford, NJ 08084-1729 | 2006-12-16 |
| 1679652531 | Harry Crisfield Brown | Dentist | 105 E Laurel Rd, Stratford, NJ 08084-1324 | 2006-11-03 |
| 1124109756 | Gerald Alan Belkin | Dentist | 2318 Main Street, Stratford, CT 06615 | 2006-10-18 |
| 1497840706 | Krystyna Zietkiewicz | Dentist | 88 Ryders Lane, Stratford, CT 06614 | 2006-10-03 |
| 1346359544 | Frank A. Ross Jr. | Dentist | 1761 W Broad St, Stratford, CT 06615-5752 | 2006-08-30 |
| 1609886480 | Stratford Dental Care PC | Dentist | 373 Nichols Ave, Stratford, CT 06614 | 2006-08-08 |
| Find all providers in STRATFORD | ||||
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| 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.