NPIMap

Organization Active NPI

Brass Mill Mall Dental L.L.P

  • General Practice Dentistry
  • Waterbury, CT
National Provider Identifier
1629263850
Registry record updated Mar 18, 2015
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
008698 Issued in CT
Legal business name
BRASS MILL MALL DENTAL L.L.P
Practice address
495 Union St
Stuite 1016
Waterbury, CT 06706-1292
Phone
(203) 574-2121
NPI assigned
Sep 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2015

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

Authorized official

Name
Dr. Ross Krasnov
Title
Owner
Phone
(860) 676-2828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 008698 CT Primary

Addresses

Primary practice location

495 Union St
Stuite 1016
Waterbury, CT 06706-1292

Mailing address

495 Union St
Stuite 1016
Waterbury, CT 06706-1292
Phone (203) 574-2121

National Provider Directory

National Provider Directory

Locations

495 Union St
Ste 1016
Waterbury, CT 06706
Phone (203) 574-2121

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426636800000",
    "number": "1629263850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 UNION ST",
            "address_2": "STUITE 1016",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061292",
            "telephone_number": "203-574-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 UNION ST",
            "address_2": "STUITE 1016",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061292",
            "telephone_number": "203-574-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRASS MILL MALL DENTAL L.L.P",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2015-03-18",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-676-2828",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "008698",
            "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 Mar 18, 2015; 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.