Individual
SREE RAGHAVENDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-1000
(860) 679-3415
(860) 679-7507
Mailing address
263 FARMINGTON AVE, MC3905, FARMINGTON, CT 06030-3905
(860) 679-2207
(860) 679-1899
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
009176
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236354
—
CT
Enumeration date
07/12/2006
Last updated
05/12/2021
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