| NPI | 1417152786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG STEPHEN WILSON Owner 860-388-9774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 006836) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2020-08-22 |