| NPI | 1114331931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN MARGARET GLAZER Member 860-575-0594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CT 009873) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-08-11 |