| NPI | 1215123807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA KEENEY Office Manager 860-886-0651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2011-11-10 |