| NPI | 1154745867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESUS A VILLEGAS Pediatric 203-876-9965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 008668) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| Enumeration Date | 2014-02-17 |
| Last Update Date | 2014-09-11 |