NPIMap

Organization Active NPI

West Main Dental Associates

  • General Practice Dentistry
  • Waterbury, CT
National Provider Identifier
1720204415
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5521 Issued in NY
Legal business name
WEST MAIN DENTAL ASSOCIATES
Practice address
1147 W Main St
Waterbury, CT 06708-2737
Phone
(203) 755-5641
NPI assigned
Apr 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2012

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

Authorized official

Name
Dr. Terence E Hickey, D.M.DNPI 1598789729
Title
President
Phone
(203) 755-5641

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 4391 CT
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 5521 NY Primary

Addresses

Primary practice location

1147 W Main St
Waterbury, CT 06708-2737

Mailing address

1147 W Main St
Waterbury, CT 06708-2737
Phone (203) 755-5641

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1720204415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 W MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082737",
            "telephone_number": "203-755-5641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 W MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082737",
            "telephone_number": "203-755-5641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST MAIN DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "HICKEY",
        "authorized_official_first_name": "TERENCE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-755-5641",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "4391",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "5521",
            "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 May 10, 2012; 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.