| NPI | 1063754976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GIL DAVID BOISONEAU Owner 860-643-0688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| 126800000X Dental Assistant | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2013-03-19 |