| NPI | 1013191212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JEFFREY WIENER Owner 203-889-0278 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 008178) |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2012-11-13 |