Active NPI
Roman Shamuelov, DDS
- General Practice Dentistry
- Waterbury, CT
National Provider Identifier
1346559499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 010277
- Practice address
- 1127 West Main Street
Waterbury, CT 06708 - Phone
- (203) 573-9989
- Fax
- (203) 759-0239
- NPI assigned
- Oct 6, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 010277 | CT | Primary |
Addresses
Primary practice location
1127 West Main Street
Waterbury, CT 06708
Mailing address
1127 West Main Street
Waterbury, CT 06708
Phone (203) 573-9989
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010277 | CT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286323200000",
"number": "1346559499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1127 WEST MAIN STREET",
"city": "WATERBURY",
"state": "CT",
"postal_code": "06708",
"telephone_number": "203-573-9989",
"fax_number": "203-759-0239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1127 WEST MAIN STREET",
"city": "WATERBURY",
"state": "CT",
"postal_code": "06708",
"telephone_number": "203-573-9989",
"fax_number": "203-759-0239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAMUELOV",
"first_name": "ROMAN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-06",
"last_updated": "2010-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "010277",
"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 Oct 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.