| NPI | 1194332619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS SHANNON Dds 860-481-7631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-09-29 |