| NPI | 1285204347 |
|---|---|
| Doing Business As | SOUTH AVENUE DENTAL |
| Entity Type | Organization |
| Authorized Contact | LAJJA PATEL Owner 203-889-5379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2021-06-30 |