| NPI | 1376836742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINA VELEZ Office Manager 203-481-0338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 010722) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: CT 261QD0000X) |
| 1223G0001X Dentist, General Practice (Licence: CT 9256) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 9256) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 9256) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2015-09-08 |