| NPI | 1457709180 |
|---|---|
| Former Legal Business Name | NOBEL PERIO |
| Entity Type | Organization |
| Authorized Contact | LEAH ANN MAYLOTT Credentialing Administrator 860-874-8198 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA 19671) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2022-01-18 |