Dental Group of Waterbury, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

008810 Issued in CT

Legal business name

DENTAL GROUP OF WATERBURY, LLC

Practice address

1127 W Main St
Waterbury, CT 06708-2764

Phone

(203) 573-9989

Fax

(203) 759-0239

NPI assigned

Mar 8, 2010

Organization subpart

No

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

Authorized official

Name

Roxanne Tamayo-Bordies, DDS

Title

Owner

Phone

2032035739989

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

{
    "created_epoch": "1268006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1164745956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 W MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082764",
            "telephone_number": "203-573-9989",
            "fax_number": "203-759-0239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 W MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082764",
            "telephone_number": "203-573-9989",
            "fax_number": "203-759-0239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL GROUP OF WATERBURY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-08",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "TAMAYO-BORDIES",
        "authorized_official_first_name": "ROXANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "2032035739989",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "008810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Demirs
• Summer Marie Denby, LCSW
• Samir Dengle, M.D.
• Esma W Dennis, BS
• Dental Dreams, LLC
• Monica Rose Depaolo, RDH
• Catrina Derby, LPC
• Dermatology Associates of Wtby PC
• Elias Constantine Deros, DMD
• Priya Desai, M.D., MSC.

• Dentist in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.