FARISA SURATTANONT DDS (Credential# 703608) is licensed (Dentist) with Connecticut Department of Consumer Protection. The license effective date is February 13, 2004. The license expiration date date is February 28, 2005. The license status is INACTIVE.
FARISA SURATTANONT DDS is licensed with the Department of Consumer Protection of Connecticut. The credential number is #2.009156. The credential type is dentist. The effective date is February 13, 2004. The expiration date is February 28, 2005. The business address is 189 Daniel Brown Drive, Mystic, CT 06355. The current status is inactive.
| Licensee Name | FARISA SURATTANONT DDS |
| Credential ID | 703608 |
| Credential Number | 2.009156 |
| Credential Type | Dentist |
| Business Address |
189 Daniel Brown Drive Mystic CT 06355 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2003-06-04 |
| Effective Date | 2004-02-13 |
| Expiration Date | 2005-02-28 |
| Refresh Date | 2009-07-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 343335 | CSP.0033742 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2004-02-29 - 2005-02-28 | INACTIVE |
| Street Address | 189 DANIEL BROWN DRIVE |
| City | MYSTIC |
| State | CT |
| Zip Code | 06355 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| John R Roorbach | 30 Starr Lane, Mystic, CT 06355 | Licensed Clinical Social Worker | 2020-09-01 ~ 2021-08-31 |
| David L Atkinson | 1184 River Road, Mystic, CT 06355 | Architect | 2020-08-01 ~ 2021-07-31 |
| Angies Pier 27 · Angies Pizza of Stoning D | 25 Roosevelt Ave, Mystic, CT 06355 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Patricia A Halvordson | 287 Judson Avenue, Mystic, CT 06355 | Dietitian/nutritionist | 2020-09-01 ~ 2021-08-31 |
| Adam A Velez | 78 Denison Avenue, Mystic, CT 06355 | Real Estate Salesperson | ~ |
| Munson's Chocolates | Old Mystic Village, Mystic, CT 06355 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Mark A Comeau | 6 School Street, Mystic, CT 06355 | Architect | 2020-08-01 ~ 2021-07-31 |
| Mekhael E Srour | 2 Stonington Road, Mystic, CT 06355 | Real Estate Salesperson | ~ |
| Courtney Jane Littlewood | 244 High Meadow Ln, Mystic, CT 06355 | Master's Level Social Worker | 2020-07-01 ~ 2021-06-30 |
| Franklins General Store · H Supply Co Inc Dba | Olde Mistick Village, Mystic, CT 06355 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06355 | |||
| City | MYSTIC |
| Zip Code | 06355 |
| License Type | Dentist |
| License Type + County | Dentist + MYSTIC |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Tahasha Farisa | 225 Orbit Dr, Lavon, TX 75166-1872 | Registered Nurse | 2018-10-04 ~ 2019-05-31 |
| Ana L Roca | 331 2nd Ave # 2, Garwood, NJ 07027-1004 | Dentist | ~ |
| Priscila M Guzman | CT | Dentist | ~ |
| Narinderjit Mahal | CT | Dentist | ~ |
| Su J Lee | 480 2nd Ave Apt 10a, New York, NY 10016-9140 | Dentist | 2016-07-12 ~ 2017-03-31 |
| Jay F Ponto | 302 2nd St Apt 7b, Brooklyn, NY 11215-8507 | Dentist | 2019-07-01 ~ 2020-06-30 |
| Su Jung Kim | 111 Park St Apt 12t, New Haven, CT 06511-5421 | Dentist | ~ |
| Heeyeon Lee | 520 2nd Ave Apt 13c, New York, NY 10016-8621 | Dentist | 2014-04-01 ~ 2015-04-30 |
| Charles E Ray | P.o. Box E, Middlebury, CT 06762 | Dentist | 2007-04-26 ~ 2008-05-31 |
| Keren Etzion | 395 S End Ave Apt 6n, New York, NY 10280-1049 | Dentist | ~ |
Please comment or provide details below to improve the information on FARISA SURATTANONT DDS.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).