| NPI | 1225508526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAQUEL FONTAINE Business Manager 860-430-5687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Additional Taxonomies | 122300000X Dentist |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 207QS1201X Family Medicine, Sleep Medicine | |
| 208VP0000X Pain Medicine, Pain Medicine | |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2018-11-29 |