Individual
EDWARD ROBERT FOURNIER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
405 N MAIN ST, BRISTOL, CT 06010-4924
(860) 584-0171
Mailing address
1738 WOLCOTT RD, WOLCOTT, CT 06716-1325
(203) 879-2609
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5373
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020005373CT01
ANTHEM BLUE CROSS
CA
01
—
020005373CT01
UNITED HEALTH CARE-DENTAL
UT
Enumeration date
07/26/2006
Last updated
12/19/2012
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