| NPI | 1164567111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN MICHELINE ALMEIDA Office Administrator 860-665-0444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 4731) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 5832) |
| 1223P0300X Dentist, Periodontics (Licence: CT 5407) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |