Provider Demographics
NPI:1861762635
Name:RONALD B HERRIOTT DMD PC
Entity type:Organization
Organization Name:RONALD B HERRIOTT DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGASSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-523-6549
Mailing Address - Street 1:259 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3969
Mailing Address - Country:US
Mailing Address - Phone:860-583-6549
Mailing Address - Fax:860-528-1547
Practice Address - Street 1:259 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3969
Practice Address - Country:US
Practice Address - Phone:860-583-6549
Practice Address - Fax:860-528-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004732204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty