| NPI | 1023155363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL YVONNE CHIARELLO Business Manager 860-677-8666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 10532) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 5359) |
| 122300000X Dentist (Licence: CT 5775) | |
| 122300000X Dentist (Licence: CT 8373) | |
| 122300000X Dentist (Licence: CT 8737) | |
| 122300000X Dentist (Licence: CT 8597) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2017-02-06 |