Provider Demographics
NPI:1124643986
Name:NFD
Entity type:Organization
Organization Name:NFD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:YASEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-633-6167
Mailing Address - Street 1:14 PASTURE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2322
Mailing Address - Country:US
Mailing Address - Phone:484-664-9623
Mailing Address - Fax:
Practice Address - Street 1:875 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-2218
Practice Address - Country:US
Practice Address - Phone:860-633-6167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty