| 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 |