Provider Demographics
NPI:1336214956
Name:WATERFORD DENTAL HEALTH
Entity Type:Organization
Organization Name:WATERFORD DENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-447-2235
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-447-2235
Mailing Address - Fax:860-444-2992
Practice Address - Street 1:177 BOSTON POST ROAD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-447-2235
Practice Address - Fax:860-444-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44851223G0001X
CT61801223G0001X
CT77841223G0001X
CT79461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty