| NPI | 1245671551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN LISSAUER President 203-440-9449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2013-07-15 |