Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6826 | CT |
NPI | 1053305201 |
---|---|
Provider Name | Dr. Philip J Conforti |
First Address | Guilford, CT 06437-2723 |
Second Address | Hamden, CT 06514-1852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 17/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U20696 | (02) |