NPIMap

Organization Active NPI

Waterbury Family Dental P.C.

  • Dentist
  • Waterbury, CT
National Provider Identifier
1689997124
Registry record updated Mar 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
010025 Issued in CT
Legal business name
WATERBURY FAMILY DENTAL P.C.
Practice address
155 Thomaston Ave
C12
Waterbury, CT 06702-1020
Phone
(203) 288-3000
Fax
(203) 288-3004
NPI assigned
Mar 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2010

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

Authorized official

Name
Mr. Kanye Michael Bosma
Title
Manager
Phone
(203) 288-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 010025 CT Primary

Addresses

Primary practice location

155 Thomaston Ave
C12
Waterbury, CT 06702-1020

Mailing address

155 Thomaston Ave
C12
Waterbury, CT 06702-1020
Phone (203) 288-3000

National Provider Directory

National Provider Directory

Locations

155 Thomaston Ave
#C12
Waterbury, CT 06702
Phone (203) 288-3000

NPI Registry JSON

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268265600000",
    "number": "1689997124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 THOMASTON AVE",
            "address_2": "C12",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021020",
            "telephone_number": "203-288-3000",
            "fax_number": "203-288-3004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 THOMASTON AVE",
            "address_2": "C12",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021020",
            "telephone_number": "203-288-3000",
            "fax_number": "203-288-3004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERBURY FAMILY DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-11",
        "last_updated": "2010-03-11",
        "status": "A",
        "authorized_official_last_name": "BOSMA",
        "authorized_official_first_name": "KANYE",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "203-288-3000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "010025",
            "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 11, 2010; 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.