| NPI | 1114422557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SRINIVAS R DURSHANAPALLI Manager 203-215-4687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-04-13 |