Waterbury Family Dentistry, PLC

Primary specialty

DentistTaxonomy code 122300000X

License

0160001187 Issued in VT

Legal business name

WATERBURY FAMILY DENTISTRY, PLC

Practice address

77 S. Main St.
Suite 3
Waterbury, VT 05676

Phone

(802) 244-6366

Fax

(802) 244-8514

NPI assigned

Jul 18, 2007

Organization subpart

No

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

Authorized official

Name

Gary L. Morris, DDS

Title

Owner/Dentist

Phone

(802) 244-6366

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318291200000",
    "number": "1275733354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 S. MAIN ST.",
            "address_2": "SUITE 3",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "05676",
            "telephone_number": "802-244-6366",
            "fax_number": "802-244-8514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 S. MAIN ST.",
            "address_2": "SUITE 3",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "05676",
            "telephone_number": "802-244-6366",
            "fax_number": "802-244-8514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERBURY FAMILY DENTISTRY, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-18",
        "last_updated": "2011-10-11",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "802-244-6366",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "VT",
            "license": "0160001187",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "VT",
            "license": "2031",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004239",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Waterbury, VT
• Providers in Waterbury, VT by specialty
• Dentist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2011; 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.