Provider Demographics
NPI:1306597836
Name:NEW HAVEN KIDS DENTISTRY
Entity type:Organization
Organization Name:NEW HAVEN KIDS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:YSAAC-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-767-3798
Mailing Address - Street 1:1463 WHALLEY AVE # 2D
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1153
Mailing Address - Country:US
Mailing Address - Phone:203-767-3798
Mailing Address - Fax:
Practice Address - Street 1:1463 WHALLEY AVE # 2D
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1153
Practice Address - Country:US
Practice Address - Phone:203-767-3798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental