| NPI | 1114815776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAGGIE JEAN MCCLAIN Transitions/Operations Manager 860-269-0628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2025-06-24 |