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Organization
WEST MAIN DENTAL ASSOCIATES
Active
Organization
WEST MAIN DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERENCE E HICKEY D.M.D (PRESIDENT)
(203) 755-5641
Entity
Organization
Contact information
Practice address
1147 W MAIN ST, WATERBURY, CT 06708-2737
(203) 755-5641
Mailing address
1147 W MAIN ST, WATERBURY, CT 06708-2737
(203) 755-5641
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
4391
CT
1223G0001X
General Practice Dentistry
Primary
5521
NY
Other
Enumeration date
04/18/2007
Last updated
05/10/2012
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