Individual
POOJA BYSANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-2820
(860) 679-3170
(860) 679-8162
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-2820
(860) 206-3830
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10166
CT
1223G0001X
General Practice Dentistry
50891
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10166
—
CT
Enumeration date
08/10/2006
Last updated
12/29/2010
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