Waterview Dental Group, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10439 Issued in CT

Legal business name

WATERVIEW DENTAL GROUP, LLC

Practice address

553 Portland Cobalt Rd
Portland, CT 06480-1968

Phone

(860) 342-4141

Fax

(860) 342-1284

NPI assigned

Jul 15, 2015

Last updated

Jul 15, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sueyoung CHI, DDS

Title

Owner/Partner

Phone

(860) 342-4141

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436918400000",
    "number": "1881078327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 PORTLAND COBALT RD",
            "city": "PORTLAND",
            "state": "CT",
            "postal_code": "064801968",
            "telephone_number": "860-342-4141",
            "fax_number": "860-342-1284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 PORTLAND COBALT RD",
            "city": "PORTLAND",
            "state": "CT",
            "postal_code": "064801968",
            "telephone_number": "860-342-4141",
            "fax_number": "860-342-1284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERVIEW DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-15",
        "last_updated": "2015-07-15",
        "status": "A",
        "authorized_official_last_name": "CHI",
        "authorized_official_first_name": "SUEYOUNG",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "860-342-4141",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "10439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evan Toner-Cao, MD
• Carin Tripodina, RN
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• Katelyn Mary Warner, LPC
• Deborah D Webster, P.T.
• Emily Wickman
• Kristen Johanna Mary Wils, MD
• Edward Paul Wysocki Jr., D.M.D.
• Leigh Suzanne Young, LPN

• General Practice Dentistry in Portland, CT
• Providers in Portland, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.