RAWAN J.J. SARSOUR (Credential# 2021190) is licensed (Provisional Faculty Dentist) with Connecticut Department of Consumer Protection. The license effective date is April 21, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.
RAWAN J.J. SARSOUR is licensed with the Department of Consumer Protection of Connecticut. The credential number is #2.012723-PROV. The credential type is provisional faculty dentist. The effective date is April 21, 2020. The expiration date is April 30, 2021. The business address is 263 Farmington Ave # Mc3905, Farmington, CT 06030-0001. The current status is active.
| Licensee Name | RAWAN J.J. SARSOUR |
| Credential ID | 2021190 |
| Credential Number | 2.012723-PROV |
| Credential Type | Provisional Faculty Dentist |
| Credential SubCategory | PROV |
| Business Address |
263 Farmington Ave # Mc3905 Farmington CT 06030-0001 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2020-04-21 |
| Effective Date | 2020-04-21 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-04-22 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1488191 | 2.012068-RES | Resident Dentist | 2016-07-01 | 2016-07-01 - 2019-06-30 | INACTIVE |
| Street Address | 263 FARMINGTON AVE # MC3905 |
| City | FARMINGTON |
| State | CT |
| Zip Code | 06030-0001 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Niloufar Azami | 263 Farmington Ave # Mc3905, Farmington, CT 06030-0001 | Resident Dentist | 2016-07-01 ~ 2019-06-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Wendy A Miller | Mc1921 Farmington Ave # 263, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jason J Ziegler | 2 Courthouse Square, Farmington, CT 06030-0001 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Bryden T Considine | L2104 of Medicine Rm, Farmington, CT 06030-0001 | Resident Physician | 2017-07-03 ~ 2021-06-30 |
| Dillon Paulo | 4260 Cordoba Ct, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Erica Shen Nofziger | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2027-06-30 |
| Omar Ibrahim | 263 Farmington Ave # Mc-1321, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jillian L Fortier | Uconn Health Center, Department of Surgery, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Douglas Zelisko | 263 Farmington Ave Dept Of, Farmington, CT 06030-0001 | Physician/surgeon | 2020-04-23 ~ 2021-01-31 |
| Ruchir D Trivedi | 263 Farmington Ave # Mc-1405, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Angela Hart | General Medicine- Outpatient Pavilion, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Find all Licenses in zip 06030-0001 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Eric Anthony Brueckner | 263 Farmington Ave., Farmington, CT 06030 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Derrick B Bremang | Residency Program, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
| David M Shafer | Uconn Health Center, Farmington, CT 06030 | Dentist | 2020-07-01 ~ 2021-06-30 |
| Michael J Murphy | Dept of Dermatology, Farmington, CT 06030 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Richard F Kaplan | Univ. of Ct., Farmington, CT 06030 | Psychologist | 2020-06-01 ~ 2021-05-31 |
| Nicholas George Vitale | 22 Woods Drive, Norwich, CT 06030 | Casino Class I Employee | 2019-12-03 ~ 2020-10-31 |
| Bruce E Gould | Univ of Conn Health Center, Farmington, CT 06030 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Vinayak M Sathe | Uconn Health Center,263 Farmington Ave, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Shobhana Pathani | Department of Medicine, 263 Farmington Ave, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Patricia L Almeida | John Dempsey Hospital, Farmington, CT 06030 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
| Find all Licenses in zip 06030 | |||
| City | FARMINGTON |
| Zip Code | 06030 |
| License Type | Provisional Faculty Dentist |
| License Type + County | Provisional Faculty Dentist + FARMINGTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Rawan J Sarsour | 395 Brittany Farms Rd Apt 411, New Britain, CT 06053-1155 | Controlled Substance Registration for Practitioner | 2015-07-27 ~ 2017-02-28 |
| Guy Huynh-ba | 47 Avonwood Road, Avon, CT 06001 | Provisional Faculty Dentist | ~ |
| Celia M Roman | 117 Paradise Rd Fl 2, Swampscott, MA 01907-1955 | Provisional Faculty Dentist | ~ |
| Ada G Seminario | 4m Staunton Court, Farmington, CT 06032 | Provisional Faculty Dentist | ~ |
| Johanna M Musco | 19 Woodland Drive, Wallingford, CT 06492 | Provisional Faculty Dentist | ~ |
| Pooja Bysani | 54 Eddy St, Avon, CT 06001 | Provisional Faculty Dentist | 2020-05-01 ~ 2021-04-30 |
| Victoria E Barany Nunez | Farmington, CT 06032 | Provisional Faculty Dentist | 2018-09-07 ~ 2019-03-31 |
| Padma Mukherjee | 55 Maplewood Ave, West Hartford, CT 06119-1630 | Provisional Faculty Dentist | 2010-08-01 ~ 2011-07-31 |
| Rodrigo A. Haristoy | 4 Talcott Forest Rd Apt J, Farmington, CT 06032-3566 | Provisional Faculty Dentist | 2010-10-28 ~ 2011-09-30 |
| Francisco J Suarez Esser | 51 Fenwick Dr, Farmington, CT 06032-1451 | Provisional Faculty Dentist | 2020-03-01 ~ 2021-02-28 |
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| 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).