| NPI | 1063567246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLIN B. SANFORD Dentist 860-677-6405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 020005127) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 0236292) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-08-22 |