Mystic Westerly Orthodontics, PC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

8376 Issued in CT

Legal business name

MYSTIC WESTERLY ORTHODONTICS, PC

Practice address

117 Cow Hill Rd
Mystic, CT 06355-1449

Phone

(860) 536-9661

NPI assigned

Apr 30, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Todd Kozlowski, DDS

Title

President

Phone

(860) 442-4421

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Michael Thomas Depascale, DMD, MS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Mystic, CT
  • NPI 1043747116
  NPD (past)
• Richard Irwin Steinberg, DMD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Mystic, CT
  • NPI 1881724326
  NPD (past)

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

{
    "created_epoch": "1398816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398816000000",
    "number": "1174933162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 COW HILL RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551449",
            "telephone_number": "860-536-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 COW HILL RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551449",
            "telephone_number": "860-536-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC WESTERLY ORTHODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-30",
        "last_updated": "2014-04-30",
        "status": "A",
        "authorized_official_last_name": "KOZLOWSKI",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-442-4421",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CT",
            "license": "8376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mystic Medical Group, PC
• Mystic River Ambulance Association, Inc
• Mystic Services, LLC
• Mystic Spine & Sport LLC
• Mystic Therapy, LLC.
• Natura Medica
• John Jeffrey Nelson, M.D.
• New England Center for Natural Behavioral Health, LLC
• New England Chiropractic, LLC
• Kayla Nickerson Gauthier, LMFT

• Orthodontics and Dentofacial Orthopedics Dentistry in Mystic, CT
• Providers in Mystic, CT by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; 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.