Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4301 | CT |
NPI | 1033107040 |
---|---|
Provider Name | Dr. Micheal Roger Marcotte |
First Address | Bristol, CT 06010-4916 |
Second Address | Bristol, CT 06010-4916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |