Organization
GLASTONBURY DENTAL ASSOCIATES LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN C SUSAT DDS (PARTNER)
(860) 633-3671
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20772-1
UHC-GROUP
CT
01
—
Z12996
BC MA PROVIDER ID-GROUP
CT
Enumeration date
03/08/2007
Last updated
08/22/2020
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