Organization
STATE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK HOROWITZ DMD (DENTIST)
(203) 754-4175
Entity
Organization
Contact information
Practice address
1336 W MAIN ST, SUITE 2B, WATERBURY, CT 06708-3122
(203) 754-4175
(203) 596-1917
Mailing address
1336 W MAIN ST, SUITE 2B, WATERBURY, CT 06708-3122
(203) 754-4175
(203) 596-1917
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
006616
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002066167
—
CT
05
—
004116704
—
CT
Enumeration date
01/23/2014
Last updated
01/23/2014
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