| NPI | 1144528134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL A. MOORE Owner 203-869-3377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 010308) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2011-03-03 |