NPI | 1174814495 |
---|---|
Entity Type | Organization |
Authorized Contact | KIRSTEN E CAPOZZI Practice Manager 860-233-9300 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 5904) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 8915) |
1223P0300X Dentist, Periodontics (Licence: CT 5407) | |
Enumeration Date | 2011-04-20 |
Last Update Date | 2011-04-20 |