NPIMap

Organization Active NPI

Northeast Dental of Stratford,LLC

  • Dentist
  • Stratford, CT
National Provider Identifier
1851788723
Registry record updated Apr 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN20704 Issued in CT
Legal business name
NORTHEAST DENTAL OF STRATFORD,LLC
Practice address
88 Ryders LN
Stratford, CT 06614-1666
Phone
(732) 610-8265
NPI assigned
Apr 18, 2015
Last updated
Apr 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2015

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

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN20704 CT Primary

Addresses

Primary practice location

88 Ryders LN
Stratford, CT 06614-1666

Mailing address

88 Ryders LN
Stratford, CT 06614-1666
Phone (732) 610-8265

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1429315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429315200000",
    "number": "1851788723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 RYDERS LN",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066141666",
            "telephone_number": "732-610-8265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 RYDERS LN",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066141666",
            "telephone_number": "732-610-8265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST DENTAL OF STRATFORD,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-18",
        "last_updated": "2015-04-18",
        "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": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "DN20704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stratford, CT

Sources for this page

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