Provider Demographics
NPI:1336561562
Name:INTROCASO, WILLIAM HUDSON (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HUDSON
Last Name:INTROCASO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:PAUL
Other - Last Name:INTROCASO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:112 MAIN ST
Mailing Address - Street 2:STE 9
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-4730
Mailing Address - Country:US
Mailing Address - Phone:203-972-1314
Mailing Address - Fax:
Practice Address - Street 1:112 MAIN ST
Practice Address - Street 2:STE 9
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4730
Practice Address - Country:US
Practice Address - Phone:203-972-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice