| State Dental | |
|
1336 W Main St Suite 2b Waterbury CT 06708-3122 | |
| (203) 754-4175 | |
| (203) 596-1917 |
| Full Name | State Dental |
|---|---|
| Speciality | Dentist |
| Location | 1336 W Main St, Waterbury, Connecticut |
| Authorized Official Name and Position | Mark Horowitz (DENTIST) |
| Authorized Official Contact | 2037544175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Dental 1336 W Main St Suite 2b Waterbury CT 06708-3122 Ph: (203) 754-4175 | State Dental 1336 W Main St Suite 2b Waterbury CT 06708-3122 Ph: (203) 754-4175 |
| NPI Number | 1619390853 |
|---|---|
| Provider Enumeration Date | 01/23/2014 |
| Last Update Date | 01/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619390853 | NPI | - | NPPES |
| 004116704 | Medicaid | CT | |
| 002066167 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 006616 (Connecticut) | Primary |
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