| NPI | 1174026587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CAPALBO Chief Dentist 860-944-4149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: RI 2931) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: 1073658258) |
| 261QD0000X Clinic/Center, Dental (Licence: RI 1073658258) | |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2018-03-12 |