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 |