| NPI | 1225196702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY L COYLE Executive Director 860-482-3012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CT 009025) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: CT 009025) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2013-01-23 |