| NPI | 1356642540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL A MANDINO Owner 203-575-9798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 4393) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 4750) |
| 122300000X Dentist (Licence: CT 10118) | |
| 1223G0001X Dentist, General Practice | |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2014-11-10 |