Basic Information
| Provider Information | |||||||||
| NPI: | 1003018672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARTHY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 134 GRANDVIEW AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037562207 | ||||||||
| FaxNumber: | 2037562207 | ||||||||
| Practice Location | |||||||||
| Address1: | 134 GRANDVIEW AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037562207 | ||||||||
| FaxNumber: | 2037562207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 5665 | CT | Y | Dental Providers | Dentist | General Practice |
No ID Information.