| NPI | 1396120390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BALFOUR Dentist (Owner) 203-755-5641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 10493) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 11403) |
| 1223G0001X Dentist, General Practice (Licence: CT 05521) | |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2015-07-21 |