Healthcare Provider Details

I. General information

NPI: 1427083468
Provider Name (Legal Business Name): RONALD B. HERRIOTT D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 FARMINGTON AVE
BRISTOL CT
06010-3901
US

IV. Provider business mailing address

259 FARMINGTON AVE
BRISTOL CT
06010-3901
US

V. Phone/Fax

Practice location:
  • Phone: 860-583-6549
  • Fax: 860-582-1547
Mailing address:
  • Phone: 860-583-6549
  • Fax: 860-582-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number004732
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: