| NPI | 1003805524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES HARRIS Regional Director Of Reimbursement 860-714-4396 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CT 007398) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2018-04-30 |