Provider Demographics
NPI:1598876989
Name:COUTANT, ROGER D (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:COUTANT
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 1:214 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-5751
Mailing Address - Country:US
Mailing Address - Phone:860-489-3551
Mailing Address - Fax:
Practice Address - Street 1:55 PECK RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6106
Practice Address - Country:US
Practice Address - Phone:860-482-8588
Practice Address - Fax:860-482-7596
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0041441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice