Kenneth James Wachuk, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4607 Issued in CT

Practice address

185 Broad St
Suite C
Milford, CT 06460-4763

Phone

(203) 878-1173

Fax

(203) 874-1076

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Smartdental Milford LLC

  • General Practice Dentistry
  • Milford, CT
  • NPI 1265083554
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225102007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 BROAD ST",
            "address_2": "SUITE C",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064604763",
            "telephone_number": "203-878-1173",
            "fax_number": "203-874-1076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 BROAD ST",
            "address_2": "SUITE C",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064604763",
            "telephone_number": "203-878-1173",
            "fax_number": "203-874-1076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACHUK",
        "first_name": "KENNETH",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "4607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "020004607CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fedele N Volpe, D.M.D.
• Jennifer Paskiewicz Vondle, M.S., LMFT
• Victoria Rayne Vonkaenel, CCC-SLP
• Kelly Vornkahl, BCBA
• Maribeth Voytek, RPT
• Yasu Wade
• Jeffrey Allan Wagner, MD
• Wal-Mart Stores East , LP
• Ashley Waldstein
• Walgreen Co

• General Practice Dentistry in Milford, CT
• Providers in Milford, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.