Healthcare Provider Details

I. General information

NPI: 1962600544
Provider Name (Legal Business Name): JASON RANEY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SILAS DEANE HWY
WETHERSFIELD CT
06109-2134
US

IV. Provider business mailing address

465 SILAS DEANE HWY
WETHERSFIELD CT
06109-2134
US

V. Phone/Fax

Practice location:
  • Phone: 860-529-7200
  • Fax: 860-529-1050
Mailing address:
  • Phone: 860-529-7200
  • Fax: 860-529-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9474
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: