| NPI | 1407115801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRASANNA RAVURI Owner 551-404-1207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010278) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2012-05-07 |