PEDIATRIC DENTISTRY ASSOCIATES, LLC (NPI# 1740334002) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740334002 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTISTRY ASSOCIATES, LLC |
| Practice Address |
991 State St New Haven CT 06511-3993 |
| Practice Telephone | 2037873669 |
| Practice Fax Number | 2037858416 |
| Mailing Telephone | 2037873669 |
| Mailing Fax Number | 2037858416 |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2016-12-12 |
| Authorized Official Name | DOUGLAS B. KECK (OWNER) |
| Authorized Official Telephone | 2037873669 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
5525 | CT | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
7814 | CT | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | INDIVIDUAL NPI | 1710988704 | 01 |
| CT | INDIVIDUAL NPI | 1184624058 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982759791 | Pediatric Dentistry Associates, LLC | Dentist | 149 Durham Rd Ste 33, Madison, CT 06443-2680 | 2007-01-24 |
| Street Address |
991 STATE ST |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06511-3993 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184624058 | Donald William Kohn | Dentist | 991 State St, New Haven, CT 06511-3929 | 2005-07-21 |
| 1427658228 | Dr. Amy O'callaghan, LLC | Clinic/Center | 991 State St, New Haven, CT 06511-3993 | 2020-10-29 |
| 1265976260 | Colin Kong, D.m.d., LLC | Clinic/Center | 991 State St, New Haven, CT 06511-3993 | 2016-12-09 |
| 1417139916 | Kinnari Desai | Dentist | 991 State St, New Haven, CT 06511-3993 | 2007-11-27 |
| 1710988704 | Douglas B Keck | Dentist | 991 State St, New Haven, CT 06511-3993 | 2005-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194330571 | Allison Elizabeth Pratt | Occupational Therapist | 625 Whitney Ave, Apt 5, New Haeven, CT 06511 | 2020-09-11 |
| 1881213346 | Sarah Bleicher | Registered Nurse | Yale Health, 55 Lock St, New Haven, CT 06511 | 2020-04-14 |
| 1083268395 | Danielle Lee Mcpherson | Pharmacist | Yale New Haven Hospital 55 Park Street, New Haven, CT 06511 | 2019-07-25 |
| 1528533866 | Alexia Levin | Social Worker | 98/100 York St, New Haven, CT 06511 | 2018-10-12 |
| 1861970097 | Orthocare Medical Equipment LLC | Durable Medical Equipment & Medical Supplies | 1450 Chapel St Ste Sg15, New Haven, CT 06511 | 2018-07-31 |
| 1609352418 | Susannah Frew | Social Worker | 2 Eld Street, Apt 6, New Haven, CT 06511 | 2018-07-15 |
| 1851881965 | Empowerment Counseling Services, LLC | Counselor | 427 Dixwell Ave, New Haven, CT 06511 | 2018-05-14 |
| 1487173951 | Karine Giasson-gariepy | Student in an Organized Health Care Education/Training Program | Yale University Department of Psychiatry, 300 George Street, Suite 901, New Haven, Ct 06511, New Haven, CT 06511 | 2017-09-15 |
| 1568980696 | Anna Reutenauer | Dentist | 123 York St Ste 4l, New Haven, CT 06511 | 2017-09-08 |
| 1083134753 | Darin Dolezal | Student in an Organized Health Care Education/Training Program | 200 South Frontage Road, Ep2 2nd Floor - 612, Dept of Pathology, New Haven, CT 06511 | 2017-06-23 |
| Find all providers in zip 06511 | ||||
| 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 |
|---|---|---|---|---|
| 1871782458 | Sara Ysaac-garcia | Dentist | 990 State St, New Haven, CT 06511-3944 | 2007-10-18 |
| 1811027444 | Elise M Cozzi | Dentist | 860 Howard Ave, New Haven, CT 06519-1106 | 2007-03-06 |
| 1184624058 | Donald William Kohn | Dentist | 991 State St, New Haven, CT 06511-3929 | 2005-07-21 |
| 1023574845 | Sleepy Smiles Ct LLC | Dentist | 1 Park St, New Haven, CT 06504-8901 | 2019-02-17 |
| 1487144168 | Elizabeth Renee Duran | Dentist | 20 York Street, Ynhh and Pediatric Dentistry, New Haven, CT 06510-3220 | 2018-05-17 |
| 1275982647 | Swapnil Singh Mahendrakar | Dentist | 1 Long Wharf Dr, Ynhh Pediatric Dentistry, Ste 403, New Haven, CT 06511 | 2016-06-07 |
| 1720465321 | Dexter Yee | Dentist | 1 Long Wharf Dr Fl 4, New Haven, CT 06511-5991 | 2015-05-04 |
| 1245676170 | Ben S. Popple | Dentist | 20 York St # T-209, Yale-new Haven Hospital, New Haven, CT 06510-3220 | 2013-05-19 |
| 1306104682 | Michael Sultan | Dentist | 20 York St # T-209, Yale-new Haven Hospital, New Haven, CT 06510-3220 | 2012-04-24 |
| 1417139916 | Kinnari Desai | Dentist | 991 State St, New Haven, CT 06511-3993 | 2007-11-27 |
| Find all providers in NEW HAVEN | ||||
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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.