Individual
DUSTIN K WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
80 PHOENIX AVE, SUITE 201, WATERBURY, CT 06702-1418
(203) 756-8021
(203) 596-9038
Mailing address
80 PHOENIX AVE, SUITE 201, WATERBURY, CT 06702-1418
(203) 756-8021
(203) 596-9038
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
PENDING
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235968
—
CT
Enumeration date
06/04/2010
Last updated
06/04/2010
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