Organization
WEST MAIN FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL BALFOUR DDS (DENTIST (OWNER))
(203) 755-5641
Entity
Organization
Contact information
Practice address
1147 W MAIN ST, WATERBURY, CT 06708-2737
(203) 755-5641
(203) 755-1675
Mailing address
1147 W MAIN ST, WATERBURY, CT 06708-2737
(203) 755-5641
(203) 755-1675
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
05521
CT
1223G0001X
General Practice Dentistry
Primary
10493
CT
1223G0001X
General Practice Dentistry
11403
CT
Other
Enumeration date
07/21/2015
Last updated
07/21/2015
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