James J Raynor, DDS

Individual provider Active NPI General Practice Dentistry · Storrs Mansfield, CT

NPI 1669598231 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1669598231
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
4647 (CT)
Practice address
1022 Storrs Rd
Storrs Mansfield, CT 06268-2639
Phone
(860) 429-6406
Fax
(860) 429-9438
NPI assigned
Mar 22, 2007
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
4647CTMDProfessional Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4647 CT Yes

Addresses

Primary practice location

1022 Storrs Rd
Storrs Mansfield, CT 06268-2639

Mailing address

1022 Storrs Rd
Storrs Mansfield, CT 06268-2639
Phone (860) 429-6406

Other providers in Storrs Mansfield, CT

All providers in Storrs Mansfield, CT · General Practice Dentistry in Connecticut

Sources for this page

Verify at the official NPI Registry.