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General NPI Number Information
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NPI Number | 1144921065
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Entity Type | Individual
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Provider Name | LONDON MINTA DMD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 100 HOSPITAL DRIVE
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City | FARMINGTON
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State | CT
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Zip | 06030-0001
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Country | US
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Telephone | 860-367-2269
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Fax |
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Provider Business Mailing Address
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Address Line | 20 HOPMEADOW ST UNIT 534
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City | WEATOGUE
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State | CT
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Zip | 06089-7934
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 13754
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License Number State | CT
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