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Ian Jacob Fullinfaw, DDS
Student in an Organized Health Care Education/Training Program in Farmington, Connecticut
NPI 1861187205

Ian Jacob Fullinfaw is a Student in an Organized Health Care Education/Training Program based in Omaha, CT. Ian Jacob Fullinfaw practices in Farmington, CT and has the professional credentials of DDS. The NPI Number for Ian Jacob Fullinfaw is 1861187205 and holds a License No. (Connecticut).

The current practice location address for Ian Jacob Fullinfaw is 262 Farmington Avenue, Farmington, CT and can be reached out via phone at 860-679-2000.

Location: 262 Farmington Avenue, Farmington, CT, 68135-1103
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1861187205
Provider Name
Ian Jacob Fullinfaw
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
262 Farmington Avenue, Farmington, CT, 68135-1103
Phone Number
860-679-2000
Fax Number
Provider Enumeration Date
04/11/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
262 Farmington Avenue
City
Farmington
State
Connecticut
Zip
06030-0001
Phone Number
860-679-2000
Fax Number
person
Provider Business Mailing Address Details
Address
262 Farmington Avenue
City
Farmington
State
Connecticut
Zip
06030-0001
Phone Number
860-679-2000
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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