Provider Demographics
NPI:1255354957
Name:RESS, LEWIS COLIN (DDS)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:COLIN
Last Name:RESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 CONNECTICUT BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3268
Mailing Address - Country:US
Mailing Address - Phone:860-289-4080
Mailing Address - Fax:860-289-5400
Practice Address - Street 1:477 CONNECTICUT BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3268
Practice Address - Country:US
Practice Address - Phone:860-289-4080
Practice Address - Fax:860-289-5400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060896064OtherTIN