Northeast Dental of Connecticut,PC

Primary specialty

DentistTaxonomy code 122300000X

License

8979 Issued in CT

Legal business name

NORTHEAST DENTAL OF CONNECTICUT,PC

Practice address

534 Shelton Ave
Shelton, CT 06484-2804

Phone

(732) 610-8265

NPI assigned

Dec 3, 2014

Organization subpart

No

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

Authorized official

Name

Virginia Wicke

Title

Coo

Phone

(732) 610-8265

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1619374881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W CENTURY RD",
            "address_2": "SUITE 300",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076521450",
            "telephone_number": "732-610-8265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 SHELTON AVE",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064842804",
            "telephone_number": "732-610-8265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST DENTAL OF CONNECTICUT,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "WICKE",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "732-610-8265"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "8979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Shelton, CT
• Providers in Shelton, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; 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.