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General NPI Number Information
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NPI Number | 1629038062
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Entity Type | Organization
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Legal Business Name | JOHN R KASHMANIAN DMD PC
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15 A SEARLES RD
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City | POMFRET CENTER
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State | CT
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Zip | 06259
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Country | US
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Telephone | 860-928-7487
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Fax |
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Provider Business Mailing Address
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Address Line | 15 A SEARLES RD
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City | POMFRET CENTER
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State | CT
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Zip | 06259
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Country | US
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Telephone | 860-928-7487
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN R KASHMANIAN
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Credential | DMD
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Telephone | 860-928-7487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 007615
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License Number State | CT
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