Provider Demographics
NPI:1942770722
Name:C&W DENTISTRY, LLC
Entity Type:Organization
Organization Name:C&W DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WASKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-379-4809
Mailing Address - Street 1:140 WILLOW STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-2092
Mailing Address - Country:US
Mailing Address - Phone:860-379-4809
Mailing Address - Fax:860-379-4270
Practice Address - Street 1:140 WILLOW ST STE 2
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-2092
Practice Address - Country:US
Practice Address - Phone:860-379-4809
Practice Address - Fax:860-379-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1487792305OtherKIM M. WASKO
CT1285791244OtherROBERT B. CAVOLI