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Individual

RUSLANS MAIDANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
202 POMFRET ST, PUTNAM, CT 06260-1833
(860) 963-7917
(860) 963-0018
Mailing address
40 MANSFIELD AVE, WILLIMANTIC, CT 06226-2018
(860) 450-7471

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
0401414459
VA
122300000X
Dentist
Primary
11721
CT

Other

Enumeration date
07/23/2014
Last updated
10/25/2016
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