Provider Demographics
NPI:1083765267
Name:CHILDRENS DENTAL CARE OF NORWALK LLC
Entity Type:Organization
Organization Name:CHILDRENS DENTAL CARE OF NORWALK LLC
Other - Org Name:DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-866-5020
Mailing Address - Street 1:10 MOTT AVE
Mailing Address - Street 2:4C
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3320
Mailing Address - Country:US
Mailing Address - Phone:203-866-5020
Mailing Address - Fax:
Practice Address - Street 1:10 MOTT AVE
Practice Address - Street 2:4C
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3320
Practice Address - Country:US
Practice Address - Phone:203-866-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty