Provider Demographics
NPI:1356452213
Name:DORON, OFER M (DMD)
Entity Type:Individual
Prefix:DR
First Name:OFER
Middle Name:M
Last Name:DORON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OAKLAND TER
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-3020
Mailing Address - Country:US
Mailing Address - Phone:860-651-9699
Mailing Address - Fax:
Practice Address - Street 1:291 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1925
Practice Address - Country:US
Practice Address - Phone:860-677-8666
Practice Address - Fax:860-677-5839
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0085971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice