Provider Demographics
NPI:1477681237
Name:WALTER PIEROG DMD
Entity Type:Organization
Organization Name:WALTER PIEROG DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:PIEROG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-644-4209
Mailing Address - Street 1:866 FOSTER STREET EXT
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2116
Mailing Address - Country:US
Mailing Address - Phone:860-644-4209
Mailing Address - Fax:860-644-6646
Practice Address - Street 1:866 FOSTER STREET EXT
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2116
Practice Address - Country:US
Practice Address - Phone:860-644-4209
Practice Address - Fax:860-644-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0063921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1285643361Other1223G0001X