| NPI | 1376684886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA C FAIRBROTHER Practice Manager 860-232-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 003683) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 005785) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-02-05 |