Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 011629 | CT |
N | 1223D0001X | Dental Public Health | 011629 | CT |
NPI | 1124470596 |
---|---|
Provider Name | Dr. Jason Tartagni |
First Address | West Haven, CT 06516 |
Second Address | West Haven, CT 06516-4310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2016 |
Last Update Date | 08/07/2016 |