Individual
YUTDHASAK KJORNRATTANAWANICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1128 FARMINGTON AVE, BRISTOL, CT 06010-4752
(860) 585-1716
(860) 585-1758
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(315) 454-6000
(315) 454-8650
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9427
CT
Other
Enumeration date
12/16/2006
Last updated
07/08/2007
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