Provider Demographics
NPI:1861895526
Name:DENT PLUS FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:DENT PLUS FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-504-2786
Mailing Address - Street 1:99 PROSPECT ST UNIT 1C
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1636
Mailing Address - Country:US
Mailing Address - Phone:203-504-2786
Mailing Address - Fax:
Practice Address - Street 1:99 PROSPECT ST UNIT 1C
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1636
Practice Address - Country:US
Practice Address - Phone:203-504-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT112041223G0001X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty