Provider Demographics
NPI:1366610925
Name:A1 DENTALCARE
Entity type:Organization
Organization Name:A1 DENTALCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MADERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDD,PC
Authorized Official - Phone:203-576-1608
Mailing Address - Street 1:2660 MAIN ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5369
Mailing Address - Country:US
Mailing Address - Phone:203-576-1608
Mailing Address - Fax:203-333-6539
Practice Address - Street 1:2660 MAIN ST
Practice Address - Street 2:SUITE 217
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5369
Practice Address - Country:US
Practice Address - Phone:203-576-1608
Practice Address - Fax:203-333-6539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSE E. MADERA D.D.S., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty