Healthcare Provider Details

I. General information

NPI: 1629038062
Provider Name (Legal Business Name): JOHN R KASHMANIAN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 A SEARLES RD
POMFRET CENTER CT
06259
US

IV. Provider business mailing address

15 A SEARLES RD
POMFRET CENTER CT
06259
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-7487
  • Fax:
Mailing address:
  • Phone: 860-928-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number007615
License Number StateCT

VIII. Authorized Official

Name: JOHN R KASHMANIAN
Title or Position: PRESIDENT
Credential: DMD
Phone: 860-928-7487