| NPI | 1164877098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY GRILLO Partner 860-648-2848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 010565) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 5791) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2016-04-28 |