Healthcare Provider Details

I. General information

NPI: 1861762635
Provider Name (Legal Business Name): RONALD B HERRIOTT DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 FARMINGTON AVE
BRISTOL CT
06010-3969
US

IV. Provider business mailing address

259 FARMINGTON AVE
BRISTOL CT
06010-3969
US

V. Phone/Fax

Practice location:
  • Phone: 860-583-6549
  • Fax: 860-528-1547
Mailing address:
  • Phone: 860-583-6549
  • Fax: 860-528-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number004732
License Number StateCT

VIII. Authorized Official

Name: LONNIE LAGASSE
Title or Position: OFFICE MANAGER
Credential:
Phone: 860-523-6549