| NPI | 1518401066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE CASARELLA Administrator 860-276-1586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 11462) |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2019-03-12 |