| NPI | 1518234079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISHNAPRASANTH MUDUSU Owner 860-944-2802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010554) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2011-11-28 |