| NPI | 1447575055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVEN ROBERTS HENDERSON President 203-577-3500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 9463) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2010-04-07 |