| NPI | 1477919058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALEH AL KHARSA President 860-219-0933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 7893) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 7893) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 7893) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 7893) | |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2017-05-25 |