Healthcare Provider Details

I. General information

NPI: 1154380509
Provider Name (Legal Business Name): RICHARD PUTNAM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON SQ
NEW BRITAIN CT
06051-1848
US

IV. Provider business mailing address

85 LAFAYETTE STREET
NEW BRITAIN CT
06051
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-3642
  • Fax: 860-826-5557
Mailing address:
  • Phone: 860-224-3642
  • Fax: 860-826-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number008776
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: