Individual
TAM H LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
921 STATE ST, NEW HAVEN, CT 06511-3926
(203) 865-2245
Mailing address
34 W HYERDALE DR, GOSHEN, CT 06756-1801
(203) 589-4321
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8109
CT
1223G0001X
General Practice Dentistry
8109
CT
Other
Enumeration date
08/31/2006
Last updated
09/20/2023
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