Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | D7920 | CT |
Y | 204E00000X | Oral & Maxillofacial Surgeon | D7920 | CT |
NPI | 1225065295 |
---|---|
Provider Name | Dr. Andrew J Kressley |
First Address | Old Saybrook, CT 06475 |
Second Address | Old Saybrook, CT 06475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 29/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U42000 | (02) |