| NPI | 1487099172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVEN VANESSA HENDERSON Owner/Dentist 203-577-3500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CT 009463) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2013-05-08 |