Provider Demographics
NPI:1932304490
Name:TARASUK, WILLIAM ELARION (DDS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ELARION
Last Name:TARASUK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 CHASE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2942
Mailing Address - Country:US
Mailing Address - Phone:203-597-0055
Mailing Address - Fax:203-597-9083
Practice Address - Street 1:1064 CHASE PARKWAY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2942
Practice Address - Country:US
Practice Address - Phone:203-597-0055
Practice Address - Fax:203-597-9083
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT45741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics