| NPI | 1053727479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE LAVOIE Office Manager 860-644-0099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 010954) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2014-07-07 |