Provider Demographics
NPI:1194572651
Name:NORWALK KIDS DENTAL CARE, PLLC
Entity type:Organization
Organization Name:NORWALK KIDS DENTAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EFSTATHIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNOUTSOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-544-9338
Mailing Address - Street 1:10 MOTT AVE STE 4C
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3320
Mailing Address - Country:US
Mailing Address - Phone:203-544-9338
Mailing Address - Fax:
Practice Address - Street 1:10 MOTT AVE STE 4C
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3320
Practice Address - Country:US
Practice Address - Phone:203-544-9338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty