Provider Demographics
NPI:1114226255
Name:WATERBURY DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:WATERBURY DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:AGUSTO
Authorized Official - Last Name:PASCAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-756-9900
Mailing Address - Street 1:558 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1947
Mailing Address - Country:US
Mailing Address - Phone:203-756-9900
Mailing Address - Fax:203-756-9700
Practice Address - Street 1:558 CHASE AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1947
Practice Address - Country:US
Practice Address - Phone:203-756-9900
Practice Address - Fax:203-756-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0091881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008002951Medicaid