| NPI | 1346651015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM GIOVE Administrative Program Coordinator 860-679-3004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2014-05-15 |