Provider Demographics
NPI:1285925362
Name:WEST MAIN DENTAL PC
Entity type:Organization
Organization Name:WEST MAIN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HRISHIKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGATE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-939-1461
Mailing Address - Street 1:520 WEST AVE
Mailing Address - Street 2:WEST AVENUE DENTAL
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:87 W MAIN ST
Practice Address - Street 2:WEST MAIN DENTAL PC
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2216
Practice Address - Country:US
Practice Address - Phone:203-939-1461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT100891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty