Individual
DR. JAY S. MANDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
55 TOWN LINE RD, SUITE 100, WETHERSFIELD, CT 06109-4352
(860) 563-6500
(860) 563-6501
Mailing address
55 TOWN LINE RD, SUITE 100, WETHERSFIELD, CT 06109-4352
(860) 563-6500
(860) 563-6501
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5040
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5040
STATE LICENSE
—
Enumeration date
09/19/2008
Last updated
09/19/2008
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