Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 010929 | CT |
NPI | 1073877197 |
---|---|
Provider Name | Mrs. Min Deng |
First Address | Yalesville, CT 06492-2340 |
Second Address | Yalesville, CT 06492-2340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2012 |
Last Update Date | 08/09/2014 |