State Dental

LBN: State Dental
State Dental is an health care organization with primary practice located at 1336 W Main St Suite 2B, Waterbury CT 06708-3122. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty. State Dental can be contacted via phone (203) 754-4175, or through Horowitz, Mark via phone (203) 754-4175.

Contact Information

Primary practice address
1336 W Main St Suite 2B Waterbury CT 06708-3122
Phone: (203) 754-4175
Fax: (203) 596-1917
Website:
Map and Directions
Authorized official contact:
Name: Horowitz, Mark Doctor of Dental Medicine (DMD)
Phone: (203) 754-4175

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 006616 Connecticut

Profile Details

NPI number 1619390853
LBN Legal business name State Dental
DBA Doing business as
Authorized official Horowitz, Mark Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 23rd, 2014
Last updated Jan 23rd, 2014 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619390853 NPPES
Connecticut MEDICAID 004116704
Connecticut MEDICAID 002066167

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