Stephen Wallace DDS PC
Dentist, Periodontics in Waterbury, Connecticut
1629121561- Practice location
- 140 Grandview Ave, Suite 102, Waterbury, CT 06708
- Phone
- 203-753-1112
- Fax
- 203-573-0773
- Last updated
- March 22, 2012
Stephen Wallace DDS PC is a healthcare organization based in Waterbury, CT. Stephen Wallace DDS PC practices in Waterbury, CT. The NPI Number for Stephen Wallace DDS PC is 1629121561 and holds a License No. 044912-1 (NY). The current practice location address for Stephen Wallace DDS PC is 140 Grandview Ave, Suite 102, Waterbury, CT 06708 and can be reached out via phone at 203-753-1112 and via fax at 203-573-0773.
Provider Profile Details
- NPI Number
- 1629121561
- Provider Name
- Stephen Wallace DDS PC
- Provider Entity Type
- Organization
- Address
- 140 Grandview Ave, Suite 102, Waterbury, CT 06708
- Phone Number
- 203-753-1112
- Fax Number
- 203-573-0773
- Primary Taxonomy
- Dentist, Periodontics · 1223P0300X
- Organization Subpart
- No
- Authorized Official
- Mrs. Jennifer M Cathcart · Office Manager · 203-753-1112
- Provider Enumeration Date
- January 22, 2007
- Last Update Date
- March 22, 2012
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 140 Grandview Ave
Suite 102
Waterbury, CT 06708 - City
- Waterbury
- State
- Connecticut
- Zip
- 06708
- Phone Number
- 203-753-1112
- Fax Number
- 203-573-0773
Provider Business Mailing Address Details
- Address
- 140 Grandview Ave
Suite 102
Waterbury, CT 06708 - City
- Waterbury
- State
- CT
- Zip
- 06708
- Phone Number
- 203-753-1112
- Fax Number
- 203-573-0773
License Information
- License Number (1)
- 044912-1
- License State (1)
- NY
- Taxonomy (1)
- Dentist, Periodontics · 1223P0300X
- License Number (2)
- DN11169
- License State (2)
- MA
- Taxonomy (2)
- Dentist, Periodontics · 1223P0300X
- License Number (3)
- 4383
- License State (3)
- CT
- Taxonomy (3)
- Dentist, Periodontics · 1223P0300X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Dentist, Periodontics providers near Waterbury, CT
View all Dentist, Periodontics providers in Waterbury →- Dr. Michael Israel, DDSDentist, Periodontics · NPI 1710008842
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Frequently Asked Questions
What is the NPI number of Stephen Wallace DDS PC?
The NPI number of Stephen Wallace DDS PC is 1629121561. It was assigned on January 22, 2007 and is currently active in the NPPES registry.
What is the specialty of Stephen Wallace DDS PC?
Stephen Wallace DDS PC is registered under the primary taxonomy Dentist, Periodontics (code 1223P0300X), licensed in NY under license number 044912-1.
Where does Stephen Wallace DDS PC practice?
The practice location is 140 Grandview Ave, Suite 102, Waterbury, CT 06708. The office can be reached at 203-753-1112 (phone) or 203-573-0773 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1629121561 directly on the NPPES registry website.