Provider Demographics
NPI:1053132795
Name:SPH NORTH HAVEN LLC
Entity type:Organization
Organization Name:SPH NORTH HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAE CHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-375-1388
Mailing Address - Street 1:310 WASHINGTON AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1315
Mailing Address - Country:US
Mailing Address - Phone:203-375-1388
Mailing Address - Fax:
Practice Address - Street 1:310 WASHINGTON AVE STE 5
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1315
Practice Address - Country:US
Practice Address - Phone:203-375-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty