Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 010915 | CT |
NPI | 1093945628 |
---|---|
Provider Name | Dr. Mariya Trentcheva |
First Address | Branford, CT 06405-2527 |
Second Address | Newington, CT 06111-2318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 23/08/2013 |