State Dental

Primary specialty

DentistTaxonomy code 122300000X

License

006616 Issued in CT

Legal business name

STATE DENTAL

Practice address

1336 W Main St
Suite 2B
Waterbury, CT 06708-3122

Phone

(203) 754-4175

Fax

(203) 596-1917

NPI assigned

Jan 23, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Mark Horowitz, DMD

Title

Dentist

Phone

(203) 754-4175

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Luciana C Rausch, DMD

  • Dentist
  • Waterbury, CT
  • NPI 1215069984
  NPD (past)

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

{
    "created_epoch": "1390435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390435200000",
    "number": "1619390853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1336 W MAIN ST",
            "address_2": "SUITE 2B",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067083122",
            "telephone_number": "203-754-4175",
            "fax_number": "203-596-1917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 W MAIN ST",
            "address_2": "SUITE 2B",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067083122",
            "telephone_number": "203-754-4175",
            "fax_number": "203-596-1917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-23",
        "last_updated": "2014-01-23",
        "status": "A",
        "authorized_official_last_name": "HOROWITZ",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "203-754-4175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "006616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004116704",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002066167",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcus Allen Stallworth, LMSW
• Marissa L Stankus, PA-C
• Joseph Stanley
• Sarah E. Starbird, LCSW
• Tracy Starbird, LPC
• State of Connecticut
• Joseph Statkevich, D.M.D.
• Rachael Elizabeth Staub, MS, PA-C
• Stay at Home Health Network LLC
• Staywell Health Care Inc

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.