Provider Demographics
NPI:1427083468
Name:HERRIOTT, RONALD B (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:HERRIOTT
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 1:259 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3901
Mailing Address - Country:US
Mailing Address - Phone:860-583-6549
Mailing Address - Fax:860-582-1547
Practice Address - Street 1:259 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3901
Practice Address - Country:US
Practice Address - Phone:860-583-6549
Practice Address - Fax:860-582-1547
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0047321223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0045351OtherUS HEALTHCARE
CTHAS084OtherOXFORD HEALTHPLAN
CT00844450OtherUNITED CONCORDIA
CTOV1955OtherHEALTHNET
CT0045704OtherAETNA
CT020004732CT01OtherANTHEM
CO25186OtherM.D. HEALTHPLAN
CT770135OtherCONNECTICARE
CT0194341-003OtherCIGNA HEALTHPLAN
CTT23877Medicare UPIN