| NPI | 1063700037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT RUSSELL SORRENTINO President 203-787-6581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 5139) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2011-07-12 |