Provider Demographics
NPI:1437234523
Name:COMMERCE PARK DENTAL GROUP LLC
Entity type:Organization
Organization Name:COMMERCE PARK DENTAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DINKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-371-8282
Mailing Address - Street 1:4702 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1823
Mailing Address - Country:US
Mailing Address - Phone:203-371-8282
Mailing Address - Fax:203-371-4229
Practice Address - Street 1:4702 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1823
Practice Address - Country:US
Practice Address - Phone:203-371-8282
Practice Address - Fax:203-371-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056941223P0221X
CT0077891223P0221X
CT0092051223P0221X
CT0070361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty