Individual
JAIMIE VASSILIOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
733 TERRYVILLE AVE, BRISTOL, CT 06010-4034
(860) 584-0441
Mailing address
410 EMMETT ST UNIT 7, BRISTOL, CT 06010-8601
(860) 302-2174
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS040234
PA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
011467
CT
Other
Enumeration date
01/09/2015
Last updated
11/02/2015
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