| NPI | 1073041489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH MAINVILLE Office Manager 860-404-5494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CT 7753) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2017-05-30 |