| NPI | 1447548805 |
|---|---|
| Doing Business As | LONG RIDGE DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | TAE CHUL HO Owner 860-342-4141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 9846) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 9920) |
| 261QD0000X Clinic/Center, Dental (Licence: CT 009846) | |
| 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: CT 009846) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2014-02-17 |