| NPI | 1346233061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M JORDAN Owner/Dentist 860-688-2679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 007567) |
| Enumeration Date | 2005-08-28 |
| Last Update Date | 2020-08-22 |