Provider Demographics
NPI:1538558622
Name:CHILDRENS DENTISTRY OF TRUMBULL, PC
Entity type:Organization
Organization Name:CHILDRENS DENTISTRY OF TRUMBULL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:YSAAC-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-767-3798
Mailing Address - Street 1:5211 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1040
Mailing Address - Country:US
Mailing Address - Phone:203-767-3798
Mailing Address - Fax:
Practice Address - Street 1:999 SILVER LN
Practice Address - Street 2:2D
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5343
Practice Address - Country:US
Practice Address - Phone:203-590-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT109941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty