MEDICARE: JONATHAN S KORN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	009053	CT
2	1223G0001X	General Practice Dentistry	009053	CT

General Provider Information

NPI Number	:	1174629612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN S KORN

Provider Business Mailing Address
First Line	:	49 LEXINGTON ST
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06052-1416
Country	:	US
Telephone Number	:	860-229-9928
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 LEXINGTON ST
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06052-1416
Country	:	US
Telephone Number	:	860-229-9928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	01/06/2015

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Directions to “ JONATHAN S KORN ” Practice Location

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