Healthcare Provider Details

I. General information

NPI: 1851444137
Provider Name (Legal Business Name): JOHN PRINTUP D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HEBRON AVE
GLASTONBURY CT
06033-4211
US

IV. Provider business mailing address

30 HEBRON AVE
GLASTONBURY CT
06033-4211
US

V. Phone/Fax

Practice location:
  • Phone: 860-633-2666
  • Fax: 860-633-3084
Mailing address:
  • Phone: 860-633-2666
  • Fax: 860-633-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5872
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: