| NPI | 1093034621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLIVE B. RUSELL Part Owner/Manager 203-338-0090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: CT 006295) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 009777) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2010-05-21 |