| NPI | 1285651133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCHANTAL MARY THIELKE Billing & Insurance Manager 860-678-7528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2025-07-21 |