| NPI | 1053782060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB MARSHALL GADY President 860-231-1030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CT 011331) |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2022-10-17 |