ELLYN G MIX DMD
Controlled Substance Registration for Practitioner


Address: 36 Padanaram Road, Danbury, CT 06811

ELLYN G MIX DMD (Credential# 147711) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2006. The license expiration date date is February 28, 2007. The license status is INACTIVE.

Business Overview

ELLYN G MIX DMD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0011488. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2006. The expiration date is February 28, 2007. The business address is 36 Padanaram Road, Danbury, CT 06811. The current status is inactive.

Basic Information

Licensee Name ELLYN G MIX DMD
Credential ID 147711
Credential Number CSP.0011488
Credential Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
Business Address 36 Padanaram Road
Danbury
CT 06811
Business Type INDIVIDUAL
Status INACTIVE
Effective Date 2006-03-01
Expiration Date 2007-02-28
Refresh Date 2009-01-26

Office Location

Street Address 36 PADANARAM ROAD
City DANBURY
State CT
Zip Code 06811

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City DANBURY
Zip Code 06811
License Type CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
License Type + County CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + DANBURY

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Dataset Information

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).

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