Healthcare Provider Details

I. General information

NPI: 1922136613
Provider Name (Legal Business Name): JOHN H. WATERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 EAST ST S
SUFFIELD CT
06080-0001
US

IV. Provider business mailing address

85 CHURCH ST STE 400
MIDDLETOWN CT
06457-3647
US

V. Phone/Fax

Practice location:
  • Phone: 860-627-2100
  • Fax: 860-627-2144
Mailing address:
  • Phone: 860-344-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number009598
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: