| NPI | 1467674820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANIS LAURIE CZARNOWSKI Business Manager 860-456-2906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 6192) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 6334) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2022-09-08 |