| NPI | 1215592720 |
|---|---|
| Former Legal Business Name | WICKFORD VILLAGE DENTAL, LLC |
| Entity Type | Organization |
| Authorized Contact | SAMANTHA BURNELL Manager 860-599-2505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2019-09-04 |