Provider Demographics
NPI:1386020790
Name:SNL DENTISRTY LLC
Entity type:Organization
Organization Name:SNL DENTISRTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-873-0076
Mailing Address - Street 1:1201 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5319
Mailing Address - Country:US
Mailing Address - Phone:203-873-0076
Mailing Address - Fax:203-873-0079
Practice Address - Street 1:1201 KINGS HWY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5319
Practice Address - Country:US
Practice Address - Phone:203-873-0076
Practice Address - Fax:203-873-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty