| NPI | 1376789966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLGA GONCHAROVA Owner 203-353-8532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 008984) |
| Enumeration Date | 2009-01-02 |
| Last Update Date | 2009-01-02 |