Justin Dessereaux, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11726 Issued in CT

Practice address

168 Spencer St
Manchester, CT 06040

Phone

(860) 265-8047

NPI assigned

Sep 4, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Norwich Smiles Family Dentistry

  • General Practice Dentistry
  • Norwich, CT
  • NPI 1558670471
  NPD (past)

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

{
    "created_epoch": "1472947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556755200000",
    "number": "1982151247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 TOWNWOODS RD",
            "city": "IVORYTON",
            "state": "CT",
            "postal_code": "064421270",
            "telephone_number": "203-232-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "168 SPENCER ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "06040",
            "telephone_number": "860-265-8047"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41 Castle Point Rd",
            "address_purpose": "LOCATION",
            "city": "Wappingers Falls",
            "state": "NY",
            "postal_code": "125907004",
            "country_code": "US",
            "telephone_number": "845-831-2000 x5160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "41 East Ave",
            "address_purpose": "LOCATION",
            "city": "Westerly",
            "state": "RI",
            "postal_code": "028913113",
            "country_code": "US",
            "telephone_number": "401-596-0319",
            "fax_number": "401-596-4448",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "514 W Main St",
            "address_purpose": "LOCATION",
            "city": "Norwich",
            "state": "CT",
            "postal_code": "063605321",
            "country_code": "US",
            "telephone_number": "860-889-5166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESSEREAUX",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-04",
        "last_updated": "2019-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "11726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Manchester, CT
• Providers in Manchester, 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 May 2, 2019; 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.