Provider Demographics
NPI:1629038062
Name:JOHN R KASHMANIAN DMD PC
Entity type:Organization
Organization Name:JOHN R KASHMANIAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KASHMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-928-7487
Mailing Address - Street 1:15 A SEARLES RD
Mailing Address - Street 2:
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259
Mailing Address - Country:US
Mailing Address - Phone:860-928-7487
Mailing Address - Fax:
Practice Address - Street 1:15 A SEARLES RD
Practice Address - Street 2:
Practice Address - City:POMFRET CENTER
Practice Address - State:CT
Practice Address - Zip Code:06259
Practice Address - Country:US
Practice Address - Phone:860-928-7487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007615204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
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030160OtherHEALTHNET AND HEALTHY OPT
U09692Medicare UPIN