Healthcare Provider Details

I. General information

NPI: 1467101352
Provider Name (Legal Business Name): DENNIS OWUSU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DEERFIELD CT APT D
EAST HARTFORD CT
06108-4711
US

IV. Provider business mailing address

PO BOX 280902
EAST HARTFORD CT
06128-0902
US

V. Phone/Fax

Practice location:
  • Phone: 860-890-5112
  • Fax:
Mailing address:
  • Phone: 860-890-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number0002004
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: