DUSTIN K WILDE (NPI# 1518287275) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518287275 |
| Entity Type | Individual |
| Full Name | DUSTIN K WILDE |
| Credential | DMD |
| Practice Address |
80 Phoenix Ave Suite 201 Waterbury CT 06702-1418 |
| Practice Telephone | 2037568021 |
| Practice Fax Number | 2035969038 |
| Mailing Telephone | 2037568021 |
| Mailing Fax Number | 2035969038 |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2010-06-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | PENDING | CT | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004235968 | 05 |
| Street Address |
80 PHOENIX AVE SUITE 201 |
| City | WATERBURY |
| State | CT |
| Zip Code | 06702-1418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497756902 | Michael Bass | Dentist | 80 Phoenix Ave, Suite #102, Waterbury, CT 06702-1418 | 2005-08-09 |
| 1356996920 | Raeven B Keene | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2019-08-09 |
| 1578022166 | Daedly Potusek | Nurse Practitioner | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2019-03-14 |
| 1598239873 | Ashley Corso | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2019-01-19 |
| 1326510801 | Monica Rose Depaolo | Dental Hygienist | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2018-12-21 |
| 1023536232 | Courtney Dowen | Nurse Practitioner | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2017-09-07 |
| 1851834147 | Lindsey Maloney | Nurse Practitioner | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2016-11-18 |
| 1063864346 | Miguel Mantilla | Internal Medicine | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2016-07-11 |
| 1124477518 | George Gogas | Social Worker | 80 Phoenix Ave, Suite 201, Waterbury, CT 06702-1418 | 2016-06-07 |
| 1649626300 | Irene Maturo | Dental Hygienist | 80 Phoenix Ave, Suite 201, Waterbury, CT 06702-1418 | 2016-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780120295 | Melitza Velez | Counselor | 80 Prospect St., Waterbury, CT 06702 | 2017-01-09 |
| 1467813600 | Ashley Joseph | Counselor | 30 Holmes Ave, Waterbury, CT 06702 | 2016-03-16 |
| 1649662313 | Lori Arens | Social Worker | 141 E Main St Fl 4, Waterbury, CT 06702 | 2015-03-04 |
| 1265725584 | Zelda Shleifer | Audiologist | 21 W Main St Fl Place-3, Waterbury, CT 06702 | 2011-05-19 |
| 1700024585 | Charlene Angela Jurgaitis | Durable Medical Equipment & Medical Supplies | 102 Grand Street, Waterbury, CT 06702 | 2009-02-02 |
| 1518090570 | Nathan Z Imre | Pharmacist | 161 East Main St Central Pharmacy, Waterbury, CT 06702 | 2007-03-13 |
| 1922149467 | Rachael A Petitti | Social Worker | 402 East Main Street, Waterbury, CT 06702 | 2007-02-09 |
| 1710024484 | Abbot Terrace Health Center | Assisted Living Facility | 44 Abbott Terrace, Waterbury, CT 06702 | 2007-01-31 |
| 1205994555 | Michael Arcangel Padilla | Social Worker | Western Connecticut Mental Health Network, 55 West Main Street Suite 410, Waterbury, CT 06702 | 2006-12-05 |
| 1205902723 | Colette M Anderson | Social Worker | 55 West Main St Suite 410, Western Connecticut Mental Health Network, Waterbury, CT 06702 | 2006-11-27 |
| Find all providers in zip 06702 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598245037 | Karanbeer Singh Aulakh | Dentist | Smile & Shine Dental, 158 Manor Avenue, Waterbury, CT 06705 | 2018-08-15 |
| 1417407248 | Jaswinder Gulati | Dentist | 939 Wolcott Street Unit 5b, Waterbury, CT 06705 | 2016-10-05 |
| 1952716003 | Roshanak Dezfoolian | Dentist | 714 Chase Pkwy Ste 2a, Waterbury, CT 06708-3163 | 2014-06-27 |
| 1245542620 | Kunal Narottambhai Patel | Dentist | 155 Thomaston Ave # C12, Waterbury, CT 06702-1020 | 2010-07-13 |
| 1689997124 | Waterbury Family Dental P.C. | Dentist | 155 Thomaston Ave, C12, Waterbury, CT 06702-1020 | 2010-03-11 |
| 1376674663 | Kevin Edward Reilly | Dentist | 650 Chase Parkway, Waterbury, CT 06708 | 2007-03-08 |
| 1417018805 | Stanley Deitz | Dentist | 188 Chase Ave, Waterbury, CT 06704-2245 | 2006-12-12 |
| 1811551732 | Navdeep Kaur | Dentist | 188 Chase Ave, Waterbury, CT 06704-2245 | 2019-04-25 |
| 1639555451 | Reidville Dentistry & Implants | Dentist | 464 Reidville Dr, Suite A2, Waterbury, CT 06705-2650 | 2015-08-04 |
| 1013393909 | Srilatha Dosapati | Dentist | 155 Thomaston Ave, Waterbury, CT 06702-1020 | 2015-08-03 |
| Find all providers in WATERBURY | ||||
Please comment or provide details below to improve the information on DUSTIN K WILDE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.