Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 005848 | CT |
NPI | 1003177502 |
---|---|
Provider Name | Colleen Rubano |
First Address | Cheshire, CT 06410-4232 |
Second Address | Cheshire, CT 06410-4232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 31/05/2012 |