Individual
MENA JOHNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24 PUTNAM PIKE, DAYVILLE, CT 06241-1646
(860) 779-6301
Mailing address
1783 MISSION BAY CIR APT P-306, ROCKLEDGE, FL 32955-6685
(321) 537-2810
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12364
CT
Other
Enumeration date
09/13/2018
Last updated
09/13/2018
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