Dermatology Associates of Southeastern Connecticut, P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY ASSOCIATES OF SOUTHEASTERN CONNECTICUT, P.C.

Practice address

425 Montauk Ave
New London, CT 06320-4642

Phone

(860) 442-1346

Fax

(860) 444-6208

NPI assigned

Dec 28, 2006

Organization subpart

No

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

Authorized official

Name

John Christopher Wiles, M.D.

Title

President

Phone

(806) 442-1346

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Practitioners 1

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

• Mary Ann Dionne Bentz

  • Dermatology Physician
  • Waterford, CT
  • NPI 1295720910
  Medicare reassignment NPD

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346306289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204642",
            "telephone_number": "860-442-1346",
            "fax_number": "860-444-6208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204642",
            "telephone_number": "860-442-1346",
            "fax_number": "860-444-6208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF SOUTHEASTERN CONNECTICUT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "806-442-1346",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4090841",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sophia Alexis Denniston, LCSW
• Nicole Denny, LCSW
• Bethany Brooke Denolfo, BA
• Jennifer A Derico
• Lydia Derienzo, PHARMD
• Vipasha Desai
• David Deshefy
• Ellen Lyn Deshong, LPCA
• Michelle Desousa
• Benjamin Arturo Diaz Duarte, CRNA

• Dermatology Physician in New London, CT
• Providers in New London, CT by specialty
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.