| NPI | 1013932805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD SEBASTIAN GORACY President 860-289-4848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CT 4001) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-08-22 |