Individual
BIANCA LASTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3 RESEARCH DR STE B, WOODBRIDGE, CT 06525-2345
(203) 409-2535
Mailing address
2 SKIFF ST APT 304, HAMDEN, CT 06514-1822
(631) 495-4355
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13263
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/12/2021
Last updated
06/29/2022
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