| NPI | 1134240922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BIBI KHAN Practice Manager 860-645-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2012-09-20 |