DR. KENNETH JAMES WACHUK D.D.S. NPI 1225102007

NPI Information

NPI: 1225102007
Provider Name: DR. KENNETH JAMES WACHUK, D.D.S.
Classification: Dentist - 1223G0001X
Entity Type: Individual

Specialization: General Practice

PECOS Registration: Yes

Address:
185 BROAD ST
SUITE C
MILFORD, CT
ZIP 06460
Phone: (203) 878-1173
Get Directions

DR. Kenneth James Wachuk, D.D.S. is a general practice dentist in Milford, CT. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Kenneth James Wachuk, D.D.S. NPI is 1225102007. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

185 BROAD ST
SUITE C
MILFORD, CT
ZIP 06460-763
Phone: (203) 878-1173
Fax: (203) 874-1076

The NPI 1225102007 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 11/20/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice	4607	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	020004607CT01	OTHER	CONNECTICUT	ANTHEM BCBS
2	9183875	MEDICARE ID-TYPE UNSPECIFIED	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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