| NPI | 1316456742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NISHIT R MODI Owner 860-329-6539 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2019-02-11 |