LONG RIDGE DENTAL LLC (NPI# 1356756423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356756423 |
| Entity Type | Organization |
| Organization Name | LONG RIDGE DENTAL LLC |
| Other Organization Name | LONG RIDGE DENTAL |
| Practice Address |
3741 Main St Bridgeport CT 06606-3609 |
| Practice Telephone | 4752824912 |
| Practice Fax Number | 4752824915 |
| Mailing Telephone | 4752824912 |
| Mailing Fax Number | 4752824915 |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2015-03-02 |
| Authorized Official Name | DR. KIGON SONG (OWNER) |
| Authorized Official Telephone | 6463696918 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223E0200X |
Dentist Specialization: Endodontics |
Dental Providers | ||
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers | ||
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Long Ridge Dental | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | LONG RIDGE DENTAL LLC | 161 Boston Ave, Bridgeport, CT 06610 |
| Street Address |
3741 MAIN ST |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06606-3609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922271550 | Shyam Desai | Dentist | 3741 Main St, Bridgeport, CT 06606-3609 | 2008-04-03 |
| 1548878796 | Harkirat Singh Sran | Dentist | 3741 Main St, Bridgeport, CT 06606-3609 | 2020-07-14 |
| 1902298649 | Myung-hyun Bae | Dentist | 3741 Main St, Bridgeport, CT 06606-3609 | 2015-03-03 |
| 1467754309 | Ct Braces, LLC | Dentist | 3741 Main St, Bridgeport, CT 06606 | 2010-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962023408 | Madeline Acquilano | Pharmacist | 2800 East Main St, Bridgeport, CT 06606 | 2020-05-06 |
| 1578192001 | Karin Alexandra Skalina | Student in an Organized Health Care Education/Training Program | 2800 Main St., Dept. of Medicine, Bridgeport, CT 06606 | 2020-04-06 |
| 1720641293 | Valeriia Klymenko | Student in an Organized Health Care Education/Training Program | 2800 Main Street, Department of Medicine, Bridgeport, CT 06606 | 2019-04-19 |
| 1821579996 | Ashley Liese | Nurse Practitioner | Cardiology Physicians of Fairfield County, 2679 Main St, Bridgeport, CT 06606 | 2018-08-27 |
| 1699261289 | Gema Estefania Giler-sacoto | Student in an Organized Health Care Education/Training Program | St. Vincent's Medical Center, 2800 Main Street, Department of Medicine, Bridgeport, CT 06606 | 2018-07-06 |
| 1114418365 | Jona Bumci | Physician Assistant | 3180 Main St Ste 304, Bridgeport, CT 06606 | 2018-05-23 |
| 1023471299 | Qmg4, LLC | Family Medicine | 4200 Main Street, Bridgeport, CT 06606 | 2016-04-04 |
| 1861867442 | Marie Dorothea Lisieski | Social Worker | 2400 Main Street, Bridgeport, CT 06606 | 2015-12-08 |
| 1548603384 | Gerald E. Hedley | Internal Medicine | 390 Charles Street Unit #101, Bridgeport, CT 06606 | 2013-04-11 |
| 1487997581 | Gerald Micalizzi, M.d., LLC | Radiology | 558 Fairview Avenue, Bridgeport, CT 06606 | 2013-03-27 |
| Find all providers in zip 06606 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891355814 | Kristopher Antonio Yen | Dentist | 32 Kathryn Dr, Bridgeport, CT 06610-1264 | 2019-06-20 |
| 1407239379 | Oliver Sun | Dentist | 3885 Main St Ste 101, Bridgeport, CT 06606-2814 | 2015-07-09 |
| 1679970172 | Aarti Jawa | Dentist | 594 Pequonnoack Street, Bridgeport, CT 06604 | 2014-11-26 |
| 1588064349 | Siz, LLC | Dentist | 1041-1043 East Main Street, Bridgeport, CT 06608-1916 | 2014-08-29 |
| 1306269758 | Dr.dental of Bridgeport PC | Dentist | 1700 Park Ave., Bridgeport, CT 06604-3826 | 2014-01-21 |
| 1700144714 | Hamed Ghorbani-moghaddam | Dentist | 2690 E Main St, Columbia Dental, Bridgeport, CT 06610-1422 | 2012-04-26 |
| 1831476050 | Dental Centers of Fairfiled County LLC | Dentist | 140 Hurd Ave, Bridgeport, CT 06604-2701 | 2011-11-16 |
| 1124308184 | Family Dentistry of Bridgeport P.C. | Dentist | 90 Brooklawn Ave, Bridgeport, CT 06604-2010 | 2011-08-23 |
| 1861789034 | Bridgeport Dental Care, LLC | Dentist | 2417 E Main St, Bridgeport, CT 06610-1802 | 2011-07-07 |
| 1154628477 | Bridgeport Dentist | Dentist | 2992 Main St, Bridgeport, CT 06606-4226 | 2011-02-23 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 06606 |
Please comment or provide details below to improve the information on LONG RIDGE DENTAL LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.