NPIMap

Organization Active NPI

Elias C Deros DMD LLC

  • Dentist
  • Waterbury, CT
National Provider Identifier
1033309067
Registry record updated Jul 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8029 Issued in CT
Legal business name
ELIAS C DEROS DMD LLC
Practice address
80 Phoenix Ave
Suite 305
Waterbury, CT 06702
Phone
(203) 755-4403
Fax
(203) 574-3388
NPI assigned
Jul 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elias C Deros, DMDNPI 1225259856
Title
Dentist Owner
Phone
(203) 755-4403

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 8029 CT Primary

Addresses

Primary practice location

80 Phoenix Ave
Suite 305
Waterbury, CT 06702

Mailing address

80 Phoenix Ave
Suite 305
Waterbury, CT 06702
Phone (203) 755-4403

National Provider Directory

National Provider Directory

Locations

80 Phoenix Ave
Ste 305
Waterbury, CT 06702
Phone (203) 755-4403

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185408000000",
    "number": "1033309067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 PHOENIX AVE",
            "address_2": "SUITE 305",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06702",
            "telephone_number": "203-755-4403",
            "fax_number": "203-574-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 PHOENIX AVE",
            "address_2": "SUITE 305",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06702",
            "telephone_number": "203-755-4403",
            "fax_number": "203-574-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIAS C DEROS DMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2007-07-26",
        "status": "A",
        "authorized_official_last_name": "DEROS",
        "authorized_official_first_name": "ELIAS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "203-755-4403",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "8029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.