| NPI | 1295993269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEIKH M ILYAS Dentist 203-790-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 009413) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CT 009473) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2008-05-27 |