| NPI | 1154191864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW ADAM SPARKS Sole Member/General Dentist 860-633-1809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2024-01-03 |