NPIMap

Organization Active NPI

Alan D Schupack DDS LLC

  • General Practice Dentistry
  • Wallingford, CT
National Provider Identifier
1356492185
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6675 Issued in CT
Legal business name
ALAN D SCHUPACK DDS LLC
Practice address
850 No Main Street Extension
Suite 2B
Wallingford, CT 06492
Phone
(203) 269-4249
Fax
(203) 294-4444
NPI assigned
Jan 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Alan David Schupack, DDSNPI 1508917337
Title
Manager
Phone
(203) 294-4444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6675 CT Primary

Addresses

Primary practice location

850 No Main Street Extension
Suite 2B
Wallingford, CT 06492

Mailing address

850 No Main Street Extension
Suite 2B
Wallingford, CT 06492
Phone (203) 269-4249

Other names 1

  • Alan D Schupack DDS Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356492185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 NO MAIN STREET EXTENSION",
            "address_2": "SUITE 2B",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "06492",
            "telephone_number": "203-269-4249",
            "fax_number": "203-294-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 NO MAIN STREET EXTENSION",
            "address_2": "SUITE 2B",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "06492",
            "telephone_number": "203-269-4249",
            "fax_number": "203-294-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALAN D SCHUPACK DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHUPACK",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "203-294-4444",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "6675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alan D Schupack DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Wallingford, CT

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.