Provider Demographics
NPI:1790909612
Name:MINARD, KARRI S
Entity Type:Individual
Prefix:MRS
First Name:KARRI
Middle Name:S
Last Name:MINARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 RIVER BEND RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-8040
Mailing Address - Country:US
Mailing Address - Phone:203-345-5861
Mailing Address - Fax:
Practice Address - Street 1:534 SHELTON AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-2804
Practice Address - Country:US
Practice Address - Phone:203-929-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6512124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist