| NPI | 1396352464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS SHANNON Owner 860-481-7631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2020-09-23 |