Individual
DR. JEREMY SHANE LANSFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
180 MARBERN DR, SUFFIELD, CT 06078-1535
(210) 455-5571
Mailing address
180 MARBERN DR, SUFFIELD, CT 06078-1535
(210) 455-5571
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
009319
CT
122300000X
Dentist
0401412410
VA
122300000X
Dentist
8803
TN
Other
Enumeration date
05/19/2006
Last updated
03/31/2009
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