Healthcare Provider Details

I. General information

NPI: 1568680346
Provider Name (Legal Business Name): WLADIMIR GEDEON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 WEST ST SUITE 5
DANBURY CT
06810-6525
US

IV. Provider business mailing address

93 WEST ST SUITE 5
DANBURY CT
06810-6525
US

V. Phone/Fax

Practice location:
  • Phone: 203-744-1240
  • Fax: 203-730-1455
Mailing address:
  • Phone: 203-744-1240
  • Fax: 203-730-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9151
License Number StateCT

VIII. Authorized Official

Name: DR. WLADIMIR GEDEON
Title or Position: OWNER
Credential: D.D.S.
Phone: 203-744-1240