Individual
DR. KENNETH JAMES WACHUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
185 BROAD ST, SUITE C, MILFORD, CT 06460-4763
(203) 878-1173
(203) 874-1076
Mailing address
185 BROAD ST, SUITE C, MILFORD, CT 06460-4763
(203) 878-1173
(203) 874-1076
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4607
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020004607CT01
ANTHEM BCBS
CT
Enumeration date
11/20/2006
Last updated
07/08/2007
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