Individual
KSENIA G. BAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2 STONY HILL RD, BETHEL, CT 06801
(203) 792-2263
Mailing address
2 STONY HILL RD, BETHEL, CT 06801-1063
(203) 792-2263
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
10812
CT
1223P0300X
Periodontics
Primary
10812
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004011136
—
CT
Enumeration date
06/30/2011
Last updated
05/23/2018
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