| NPI | 1558727131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMMAR IDLIBI Owner 860-584-0441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 7893) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 7893) |
| 1223G0001X Dentist, General Practice (Licence: CT 7893) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 7893) | |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2016-01-12 |