Provider Demographics
NPI:1063918787
Name:DEVOTED DENTAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:DEVOTED DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROZDOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-903-1630
Mailing Address - Street 1:37 NORTH AVE
Mailing Address - Street 2:ST 103
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:917-903-1630
Mailing Address - Fax:
Practice Address - Street 1:37 NORTH AVE
Practice Address - Street 2:ST 103
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:917-903-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Multi-Specialty