Healthcare Provider Details

I. General information

NPI: 1851744775
Provider Name (Legal Business Name): JOSHUA S. JOHN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 BOSTON POST RD UNIT 2
WATERFORD CT
06385-2053
US

IV. Provider business mailing address

262 BOSTON POST RD UNIT 2
WATERFORD CT
06385-2053
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-0861
  • Fax: 860-443-6065
Mailing address:
  • Phone: 860-443-0861
  • Fax: 860-443-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13424
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: