Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 008425 | CT |
NPI | 1033377684 |
---|---|
Provider Name | Dr. Jill Randall Danaher |
First Address | Westport, CT 06880-5500 |
Second Address | Westport, CT 06880-5500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2008 |
Last Update Date | 30/05/2008 |