| NPI | 1164835583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS VINCENT THEODOS Owner/Sole Proprietor 203-790-6288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 7113) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2015-02-27 |