Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 00826 | CT |
NPI | 1033752613 |
---|---|
Provider Name | Dr. Gregory Augustus Mckenna |
First Address | Danbury, CT 06810-7783 |
Second Address | Danbury, CT 06810-7783 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2019 |
Last Update Date | 25/10/2019 |