Park Street Family Dental
NPI #1518234079 in Hartford, Connecticut
Provider Information
- NPI Number
- 1518234079
- Entity Type
- Organization
- Organization Name
- Park Street Family Dental
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Nov 28, 2011
- Last Updated
- Nov 28, 2011
Practice Location
- Address
- 454 PARK ST
- City
- Hartford
- State
- Connecticut
- ZIP Code
- 06106-1525
- Phone
- (860) 944-2802
Authorized Official
- Name
- KRISHNAPRASANTH MUDUSU, DMD
- Title
- OWNER
- Phone
- (860) 944-2802
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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