Active NPI
Elias Constantine Deros, DMD
- Dentist
- Waterbury, CT
National Provider Identifier
1225259856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8029
- Practice address
- 80 Phoenix Ave
Suite 305
Waterbury, CT 06702 - Phone
- (203) 755-4403
- Fax
- (203) 574-3388
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8029 | CT | Primary |
Addresses
Primary practice location
80 Phoenix Ave
Suite 305
Waterbury, CT 06702
Mailing address
22 Lisbon Street
Watertown, CT 06795
Phone (203) 755-4403
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8029 | CT | MD | Dentist |
| 008029 | CT | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elias C Deros DMD LLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Waterbury, CT
- NPI 1033309067
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225259856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 LISBON STREET",
"city": "WATERTOWN",
"state": "CT",
"postal_code": "06795",
"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": {
"last_name": "DEROS",
"first_name": "ELIAS",
"middle_name": "CONSTANTINE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_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 8, 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.