| NPI | 1164864823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTINE SHAFNACKER Office Manager 860-669-4966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 5226 6138) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2013-07-23 |