| NPI | 1407572605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH ANN MAYLOTT Credentialing Administrator 860-874-8198 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2022-10-18 |