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General NPI Number Information
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NPI Number | 1932304490
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Entity Type | Individual
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Provider Name | WILLIAM ELARION TARASUK DDS
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 1064 CHASE PARKWAY
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City | WATERBURY
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State | CT
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Zip | 06708-2942
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Country | US
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Telephone | 203-597-0055
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Fax | 203-597-9083
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Provider Business Mailing Address
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Address Line | 1064 CHASE PARKWAY
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City | WATERBURY
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State | CT
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Zip | 06708-2942
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Country | US
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Telephone | 203-597-0055
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Fax | 203-597-9083
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 4574
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License Number State | CT
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