Healthcare Provider Details

I. General information

NPI: 1285294157
Provider Name (Legal Business Name): ANDREW JOSEPH MIGANI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 HEBRON AVE STE 105
GLASTONBURY CT
06033-5003
US

IV. Provider business mailing address

16 DEBBY LN
WOODBRIDGE CT
06525-1704
US

V. Phone/Fax

Practice location:
  • Phone: 860-633-1809
  • Fax: 860-633-6406
Mailing address:
  • Phone: 203-903-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12543
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: