KIDS DENTAL CARE, LLC (NPI# 1619171790) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619171790 |
| Entity Type | Organization |
| Organization Name | KIDS DENTAL CARE, LLC |
| Practice Address |
733 Terryville Ave Bristol CT 06010-4034 |
| Practice Telephone | 8605840441 |
| Practice Fax Number | 8605168918 |
| Mailing Telephone | 8605840441 |
| Mailing Fax Number | 8605168918 |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2013-07-03 |
| Authorized Official Name | DR. AMMAR IDLIBI (OWNER) |
| Authorized Official Telephone | 8605840441 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223D0004X |
Dentist Specialization: Dentist Anesthesiologist |
6903 | CT | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
10813 | CT | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
008462 | CT | Dental Providers |
| N | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
10740 | CT | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
7893 | CT | Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | KIDS DENTAL CARE, LLC | 733 Terryville Ave, Bristol, CT 06010 |
| Street Address |
733 TERRYVILLE AVE |
| City | BRISTOL |
| State | CT |
| Zip Code | 06010-4034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376569012 | Ammar Idlibi | Dentist | 733 Terryville Ave, Bristol, CT 06010-4034 | 2006-07-14 |
| 1881083137 | Jaimie Vassiliou | Dentist | 733 Terryville Ave, Bristol, CT 06010-4034 | 2015-01-09 |
| 1104172881 | Kids Dental Care Anesthesia, LLC | Anesthesiology | 733 Terryville Ave, Bristol, CT 06010-4034 | 2012-07-31 |
| 1760741318 | Eunice Dongyoon Lee | Dentist | 733 Terryville Ave, Bristol, CT 06010-4034 | 2012-05-15 |
| 1730487976 | Joseph Ross Guzzardi | Dentist | 733 Terryville Ave, Bristol, CT 06010-4034 | 2011-03-12 |
| 1891994802 | Laura P Posada-pacheco | Dentist | 733 Terryville Ave, Bristol, CT 06010-4034 | 2007-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457991309 | A New Hope Caregiving Alliance LLC | Home Health | 225 North Main Street - Suite 107, Bristol, CT 06010 | 2020-01-08 |
| 1154981777 | Georgianna Sloate Lmft, LLC | Marriage & Family Therapist | 38 Kelley Street, Bristol, CT 06010 | 2019-06-17 |
| 1962062810 | Ariel Morley | Urology | 15 Riverside Avenue, Bristol, CT 06010 | 2019-06-13 |
| 1013439488 | Theresa Rose Manolitsis | Student in an Organized Health Care Education/Training Program | 170 Pondview Lane, Bristol, CT 06010 | 2017-07-07 |
| 1588103600 | Elizabeth Anne Costello | Pharmacist | 747 Pine Street, Bristol, CT 06010 | 2017-02-22 |
| 1992157903 | Aiman Riaz | Internal Medicine | 41 Brewster Rd # 5161, Bristol, CT 06010 | 2016-07-01 |
| 1346609955 | Monika Magdalena Sullivan | Nurse Practitioner | 122 Maple Street, Bristol, CT 06010 | 2016-02-11 |
| 1346660776 | Peter Bellezza | Podiatrist | 15 Riverside Ave, Bristol, CT 06010 | 2014-04-24 |
| 1487088001 | Stephen Alexander Merwin | Social Worker | 32 Laird Drive, Bristol, CT 06010 | 2013-08-30 |
| 1215369574 | In Kyung Lee | Dentist | 1192 Farmington Ave., Bristol, CT 06010 | 2013-08-08 |
| Find all providers in zip 06010 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871791541 | Patricia M Pina | Dentist | 710 King St, Bristol, CT 06010-4477 | 2007-07-04 |
| 1063539765 | Matthew Timothy Goslee | Dentist | 255 North Main St. C/o Dr. Matt Goslee, Posner and Turkus Dds, Bristol, CT 06010 | 2007-03-26 |
| 1629088752 | Todd Edward Pillion | Dentist | 350 Blountville Hwy Ste 202, Bristol, TN 37620-1671 | 2006-08-09 |
| 1376569012 | Ammar Idlibi | Dentist | 733 Terryville Ave, Bristol, CT 06010-4034 | 2006-07-14 |
| 1386625663 | Charles H. Christ | Dentist | 350 Blountville Hwy, Suite 202, Bristol, TN 37620-0213 | 2005-11-14 |
| 1760741318 | Eunice Dongyoon Lee | Dentist | 733 Terryville Ave, Bristol, CT 06010-4034 | 2012-05-15 |
| 1730487976 | Joseph Ross Guzzardi | Dentist | 733 Terryville Ave, Bristol, CT 06010-4034 | 2011-03-12 |
| 1912174194 | Jayson C. Smith | Dentist | 350 Blountville Hwy, Suite 202, Bristol, TN 37620-0213 | 2008-05-15 |
| 1083800403 | Howard J Posner | Dentist | 255 North Main Street, Posner & Turkus Dds PC, Bristol, CT 06010 | 2007-09-19 |
| 1184847329 | Bristol Pediatric Dentistry Pllc | Dentist | 350 Blountville Hwy, Suite 202, Bristol, TN 37620-0213 | 2007-04-10 |
| Find all providers in BRISTOL | ||||
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| 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.