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General NPI Number Information
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NPI Number | 1083765267
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Entity Type | Organization
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Legal Business Name | CHILDRENS DENTAL CARE OF NORWALK LLC
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10 MOTT AVE 4C
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City | NORWALK
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State | CT
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Zip | 06850-3320
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Country | US
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Telephone | 203-866-5020
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Fax |
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Provider Business Mailing Address
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Address Line | 10 MOTT AVE 4C
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City | NORWALK
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State | CT
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Zip | 06850-3320
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Country | US
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Telephone | 203-866-5020
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CY WALD
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Credential | DMD
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Telephone | 203-866-5020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 04681
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License Number State | CT
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