Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 6010 | CT |
NPI | 1154425833 |
---|---|
Provider Name | Dr. Joseph A Cydylo JR. |
First Address | Bristol, CT 06010-4218 |
Second Address | Bristol, CT 06010-4218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 08/07/2007 |