| NPI | 1376663609 |
|---|---|
| Former Legal Business Name | AVON VILLAGE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | LAUREN M MENTASTI Owner 860-678-1140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2024-02-05 |