| NPI | 1184057192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAM H LE Member 203-248-4080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2016-02-04 |