STAMFORD PEDIATRIC DENTISTRY, LLC (NPI# 1447548805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447548805 |
| Entity Type | Organization |
| Organization Name | STAMFORD PEDIATRIC DENTISTRY, LLC |
| Other Organization Name | LONG RIDGE DENTAL GROUP |
| Practice Address |
4 Long Ridge Rd Stamford CT 06905-3802 |
| Practice Telephone | 8603424141 |
| Practice Fax Number | 8603421284 |
| Mailing Telephone | 8603424141 |
| Mailing Fax Number | 8603421284 |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2014-02-17 |
| Authorized Official Name | DR. TAE CHUL HO (OWNER) |
| Authorized Official Telephone | 8603424141 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
9920 | CT | Dental Providers |
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
009846 | CT | Ambulatory Health Care Facilities |
| N | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
009846 | CT | Ambulatory Health Care Facilities |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
9846 | CT | Dental Providers |
| Other Name | Type Code |
|---|---|
| Long Ridge Dental Group | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | STAMFORD PEDIATRIC DENTISTRY, LLC | C/o Bridgeport Dental Partners, 161 Boston Ave., Bridgeport, CT 06610 |
| Street Address |
4 LONG RIDGE RD |
| City | STAMFORD |
| State | CT |
| Zip Code | 06905-3802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396367272 | Smartport LLC | Non-emergency Medical Transport (VAN) | C/o Mollo, 1111 Summer St, Stamford, CT 06905 | 2020-05-13 |
| 1245889096 | Anna Diamantis | Counselor | 1200 High Ridge Road, 2nd Floor, Stamford, CT 06905 | 2019-09-04 |
| 1871150409 | Connecticut Anesthesia Associates LLC | Anesthesiology | 1177 High Ridge Road, Stamford, CT 06905 | 2019-05-20 |
| 1518447887 | Alexandra Petrov | Lactation Consultant, Non-RN | 42 Riverside Ave, Stamford, CT 06905 | 2018-08-16 |
| 1235640327 | A&s Chemists LLC | Pharmacy | 910 Summer Ave, Stamford, CT 06905 | 2017-10-17 |
| 1659805117 | Evolution Physical Therapy, LLC | Clinic/Center | 7 Reynolds Ave, Stamford, CT 06905 | 2017-04-11 |
| 1326587841 | Karen Poggi | Speech-Language Pathologist | 30 Buxton Farm Rd., Suite 230, Stamford, CT 06905 | 2017-02-16 |
| 1811434871 | Christina Skuburids, LLC | Point of Service | 2043 Bedford Street, Stamford, CT 06905 | 2017-01-27 |
| 1669833513 | Christian Alvarez | Occupational Therapist | 15 First St Unit 1, Stamford, CT 06905 | 2016-03-18 |
| 1932500915 | Emily Krol | Psychologist | 29 Yale Court, Stamford, CT 06905 | 2014-09-10 |
| Find all providers in zip 06905 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548502065 | Yoo Jin Shin | Dentist | 90 Fairfield Ave Lowr Level, Stamford, CT 06902-5021 | 2013-03-22 |
| 1720375041 | Gabrielle Ilyse Sykoff | Dentist | 1500 Summer Street, 2nd Floor, Stamford, CT 06905-5132 | 2011-07-07 |
| 1316268204 | Meenakshi Madhu I | Dentist | 35 W Broad St, Unit 207, Stamford, CT 06902-3766 | 2010-06-15 |
| 1750422747 | Arthur Bernard Egol | Dentist | 1 Strawberry Hill Ct, 7l, Stamford, CT 06902-2548 | 2007-02-11 |
| 1588748511 | Helene Strazza | Dentist | 127 Greyrock Place, Stamford, CT 06901 | 2006-10-25 |
| 1174132880 | Big Little Smiles Pediatric Dentistry Pllc | Dentist | 95 Morgan St Apt 1a, Stamford, CT 06905-5411 | 2020-07-28 |
| 1801358825 | Ariel Elyse Ginsberg | Dentist | 1500 Summer St, Stamford, CT 06905-5132 | 2019-04-01 |
| 1760869457 | Mariam Khan | Dentist | 127 Greyrock Pl, Stamford, CT 06901-3100 | 2015-05-01 |
| 1285980243 | You-na Kim | Dentist | 127 Greyrock Pl, Stamford, CT 06901-3100 | 2012-07-27 |
| 1740547264 | Cha Hur | Dentist | 1500 Summer St, Dental Care Kids, Stamford, CT 06905-5132 | 2012-04-22 |
| Find all providers in STAMFORD | ||||
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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.