Provider Demographics
NPI:1356492409
Name:ROSSOMANDO, KRISTI J (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:J
Last Name:ROSSOMANDO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4921
Mailing Address - Country:US
Mailing Address - Phone:203-787-1176
Mailing Address - Fax:203-787-0397
Practice Address - Street 1:825 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4921
Practice Address - Country:US
Practice Address - Phone:203-787-1176
Practice Address - Fax:203-787-0397
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice