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General NPI Number Information
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NPI Number | 1861762635
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Entity Type | Organization
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Legal Business Name | RONALD B HERRIOTT DMD PC
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 259 FARMINGTON AVE
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City | BRISTOL
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State | CT
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Zip | 06010-3969
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Country | US
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Telephone | 860-583-6549
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Fax | 860-528-1547
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Provider Business Mailing Address
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Address Line | 259 FARMINGTON AVE
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City | BRISTOL
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State | CT
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Zip | 06010-3969
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Country | US
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Telephone | 860-583-6549
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Fax | 860-528-1547
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LONNIE LAGASSE
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Credential |
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Telephone | 860-523-6549
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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 | 004732
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License Number State | CT
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