Individual
DR. KENNETH MACCORMAC II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
273 FARMINGTON AVENUE, FARMINGTON, CT 06030-0001
(860) 679-2000
Mailing address
26 LINCOLN LN, WEATOGUE, CT 06089-9780
(860) 716-2702
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
13101
CT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/16/2021
Last updated
06/03/2021
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