Healthcare Provider Details

I. General information

NPI: 1548328495
Provider Name (Legal Business Name): CHASE PARKWAY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 CHASE PARKWAY
WATERBURY CT
06708
US

IV. Provider business mailing address

714 CHASE PARKWAY
WATERBURY CT
06708
US

V. Phone/Fax

Practice location:
  • Phone: 203-757-1455
  • Fax: 203-757-2953
Mailing address:
  • Phone: 203-757-1455
  • Fax: 203-757-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateCT

VIII. Authorized Official

Name: BRETT ZANGER
Title or Position: OWNER
Credential: DMD
Phone: 203-757-1455