STEPHEN WALLACE DDS PC (NPI# 1629121561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629121561 |
| Entity Type | Organization |
| Organization Name | STEPHEN WALLACE DDS PC |
| Practice Address |
140 Grandview Ave Suite 102 Waterbury CT 06708 |
| Practice Telephone | 2037531112 |
| Practice Fax Number | 2035730773 |
| Mailing Telephone | 2037531112 |
| Mailing Fax Number | 2035730773 |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2012-03-22 |
| Authorized Official Name | MRS. JENNIFER M CATHCART (OFFICE MANAGER) |
| Authorized Official Telephone | 2037531112 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0300X |
Dentist Specialization: Periodontics |
044912-1 | NY | Dental Providers |
| N | 1223P0300X |
Dentist Specialization: Periodontics |
DN11169 | MA | Dental Providers |
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
4383 | CT | Dental Providers |
| Street Address |
140 GRANDVIEW AVE SUITE 102 |
| City | WATERBURY |
| State | CT |
| Zip Code | 06708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235131152 | Bidarkote Somanath | Pediatrics | 140 Grandview Ave, Suite No 206, Waterbury, CT 06708-2505 | 2005-08-11 |
| 1336437029 | Kathryn Spiess | Advanced Practice Midwife | 140 Grandview Ave, Suite 202, Waterbury, CT 06708-2505 | 2011-07-14 |
| 1679868822 | Stephen S Wallace | Dentist | 140 Grandview Ave, Suite 102, Waterbury, CT 06708-2505 | 2011-06-16 |
| 1245520220 | Eileen Correia-depaola | Massage Therapist | 140 Grandview Ave, Suite 104, Waterbury, CT 06708-2505 | 2011-04-12 |
| 1861704181 | Irida Molla | Internal Medicine | 140 Grandview Ave, Waterbury, CT 06708-2505 | 2010-07-02 |
| 1104070077 | Leslie Ann Torres | Social Worker | 140 Grandview Ave, Waterbury, CT 06708-2505 | 2008-11-05 |
| 1962651968 | Connecticut Kidney & Hypertension Specialists, LLC | Internal Medicine | 140 Grandview Ave, Waterbury, CT 06708-2505 | 2008-09-15 |
| 1124280631 | Meghan Marie Slemmens | Obstetrics & Gynecology | 140 Grandview Ave, Waterbury, CT 06708-2505 | 2008-06-26 |
| 1689846719 | David G. Reis Md, LLC | Specialist | 140 Grandview Ave, Suite 204, Waterbury, CT 06708-2505 | 2008-03-28 |
| 1982882882 | Sandeep Tiyyagura | Internal Medicine | 140 Grandview Ave, Suite 101, Waterbury, CT 06708-2505 | 2008-02-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952864787 | Sidhant Singh | Student in an Organized Health Care Education/Training Program | Chase Outpatient Center,160 Robbins Street, Waterbury, CT 06708 | 2019-04-09 |
| 1023574753 | Santa Maria & Schneider D.m.d Waterbury LLC | Dentist | 276 Highland Ave., Waterbury, CT 06708 | 2019-02-19 |
| 1548766959 | Caroline Johnssen | Student in an Organized Health Care Education/Training Program | Chase Outpatient Center, 160 Robbins Street, Waterbury, CT 06708 | 2018-04-04 |
| 1992209530 | Valley Wellness Consulting Group LLC | Social Worker | 969 W Main Street, Suite 3e, Waterbury, CT 06708 | 2018-03-20 |
| 1306346457 | C&s Family Dental Waterbury, LLC | Dentist | 1630 Watertown Ave, Waterbury, CT 06708 | 2018-02-15 |
| 1447759865 | Inurse Homecare, LLC. | Home Health | 140 Fulkerson Drive Unit 2c, Waterbury, CT 06708 | 2018-02-12 |
| 1619423977 | Robert Girard II | Counselor | 969 West Main Street, Suite 1 D, Waterbury, CT 06708 | 2016-08-28 |
| 1457734360 | Alternatives, Inc. | Intermediate Care Facility, Mentally Retarded | 148 Highview St, Waterbury, CT 06708 | 2015-07-09 |
| 1407266901 | Maria Munoz | Obstetrics & Gynecology | 140 Grandview Ave Ste 202, Waterbury, CT 06708 | 2014-05-06 |
| 1922420330 | Danielle Moraes | Social Worker | 276 Highland Av 2nd Fl North, Waterbury, CT 06708 | 2014-01-21 |
| Find all providers in zip 06708 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932304490 | William Elarion Tarasuk | Dentist | 1064 Chase Parkway, Waterbury, CT 06708-2942 | 2007-06-15 |
| 1679868822 | Stephen S Wallace | Dentist | 140 Grandview Ave, Suite 102, Waterbury, CT 06708-2505 | 2011-06-16 |
| 1710008842 | Michael Israel | Dentist | 26 Lakeside Blvd E, Waterbury, CT 06708-2913 | 2007-04-03 |
| 1700954856 | Wendell Philip Urling | Dentist | 60 Westwood Ave, Suite 270, Waterbury, CT 06708 | 2006-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699384966 | Connecticut Periodontal & Implant Associates | Dentist | 1080 Day Hill Rd Ste 101, Windsor, CT 06095-1781 | 2020-07-23 |
| 1790212348 | Vidushi Gupta | Dentist | 546 S Broad St Ste 2d, Meriden, CT 06450-6601 | 2017-05-15 |
| 1184057192 | Hamden Family Dental Center | Dentist | 4193 Whitney Ave, Hamden, CT 06518-1212 | 2013-08-13 |
| 1649618901 | Avon Center Dentistry | Dentist | 19 Ensign Drive, Avon, CT 06001 | 2013-06-10 |
| 1487900528 | Amazing Smiles LLC | Dentist | 148 East Ave Ste 1b, Norwalk, CT 06851-5727 | 2012-07-26 |
| 1851614002 | Patricia I Diaz-moreno | Dentist | 263 Farmington Ave # Mc2820, Farmington, CT 06030-2820 | 2010-03-02 |
| 1003045675 | Sejal Thacker | Dentist | 82 Spring Lane, West Hartford, CT 06107 | 2009-07-04 |
| 1013144039 | Stella L. Laskowski | Dentist | 74 Palomba Drive, Enfield, CT 06082 | 2009-06-17 |
| 1407019557 | Nicole Ann Marquis | Dentist | 51 Boston Post Rd, Suite 10, Madison, CT 06443-2155 | 2008-07-09 |
| 1851562466 | Arthur Fred Dean | Dentist | 489 Route 184, Suite 201, Groton, CT 06340-6227 | 2008-03-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.