| NPI | 1225241250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL FABER Member 203-354-3193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0221X Dentist, Pediatric Dentistry | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2013-12-19 |