Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7394 | CT |
NPI | 1003937301 |
---|---|
Provider Name | Dr. Jean M Lafayette |
First Address | Avon, CT 06001 |
Second Address | Bloomfield, CT 06002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020007394CT04 | BCBS (01) | CT |