| NPI | 1568409365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BAIN PATRIE Credentialing Specialist 860-347-6971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 0393) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2007-07-16 |