Individual provider Active NPI

David C Nowacki, D.M.D.

  • General Practice Dentistry
  • Newtown, CT
National Provider Identifier
1508880154
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
08241 Issued in CT
Practice address
10 Queen St
Newtown, CT 06470-2122
Phone
(203) 426-2361
Fax
(203) 426-4793
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 08241 CT Primary

Addresses

Primary practice location

10 Queen St
Newtown, CT 06470-2122

Mailing address

10 Queen St
Newtown, CT 06470-2122
Phone (203) 426-2361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150618000151 CT Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2062723018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8241CTMDProfessional Counselor
08241CTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508880154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 QUEEN ST",
            "city": "NEWTOWN",
            "state": "CT",
            "postal_code": "064702122",
            "telephone_number": "203-426-2361",
            "fax_number": "203-426-4793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 QUEEN ST",
            "city": "NEWTOWN",
            "state": "CT",
            "postal_code": "064702122",
            "telephone_number": "203-426-2361",
            "fax_number": "203-426-4793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOWACKI",
        "first_name": "DAVID",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "08241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newtown, CT

Sources for this page

Verify at the official NPI Registry.