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Individual

DR. ITZEL MEDINA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
319 FLANDERS RD, EAST LYME, CT 06333-1711
(860) 739-6915
Mailing address
331 OCEAN AVE, NEW LONDON, CT 06320-4719

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14051
CT
122300000X
Dentist
22DI02862000
NJ

Other

Enumeration date
08/24/2021
Last updated
04/06/2026
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