| NPI | 1184634313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY L WHELAN Insurance Coordinator 203-371-5595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 4982) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2007-10-01 |