Susat, Jonathan C
Susat, Jonathan C is an individual health care provider with primary practice located at 416 New London Tpke , Glastonbury CT 06033-2237. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Susat, Jonathan C can be contacted via phone (860) 633-3671.Contact Information
Primary practice address
416 New London Tpke
Glastonbury CT 06033-2237
Phone: (860) 633-3671
Fax: (860) 633-9128
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 5815 | Connecticut |
Profile Details
| NPI number | 1073644159 |
|---|---|
| LBN Legal business name | Susat, Jonathan C |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 8th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073644159 | NPPES |
| Connecticut | Other | 020005815CT01 | ANTHEM BCBS |
| Connecticut | MEDICAID | 2058154 | ANTHEM BCBS |
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