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Individual

JONATHAN C SUSAT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
416 NEW LONDON TPKE, GLASTONBURY, CT 06033-2237
(860) 633-3671
(860) 633-9128
Mailing address
416 NEW LONDON TPKE, GLASTONBURY, CT 06033-2237
(860) 633-3671
(860) 633-9128

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5815
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
020005815CT01
ANTHEM BCBS
CT
05
2058154
CT
Enumeration date
03/08/2007
Last updated
07/08/2007
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