Provider Demographics
NPI:1750957775
Name:CEDAR DENTAL TEAM PLLC
Entity type:Organization
Organization Name:CEDAR DENTAL TEAM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-241-2776
Mailing Address - Street 1:8 CAWDOR BURN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3601
Mailing Address - Country:US
Mailing Address - Phone:203-241-2776
Mailing Address - Fax:
Practice Address - Street 1:120 CLAPBOARD RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-3625
Practice Address - Country:US
Practice Address - Phone:203-744-5941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty