Individual
LINDAWATTI HERMAWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
258 S FRONTAGE RD, NEW LONDON, CT 06320-2641
(860) 437-3462
Mailing address
4319 69TH ST APT 2F, WOODSIDE, NY 11377-3974
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13169
CT
Other
Enumeration date
06/25/2021
Last updated
06/25/2021
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