| NPI | 1174893911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN CHARLES LAKES Dentist/Owner 860-537-1444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 005290) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-01-11 |